Hemorrhagic stroke: What to look for and how to prevent it
A hemorrhagic stroke is brain damage caused by bleeding in the brain. This can happen after a blood vessel bursts or if brain tissue bleeds. Early signs include a severe headache and sensitivity to light.
What is a hemorrhagic stroke?
Doctors may also use the term “intracranial hemorrhage” when talking about hemorrhagic stroke.
The bleeding in the brain puts pressure on surrounding brain cells and can cause areas of the brain to be deprived of blood. This leads to brain tissue damage, which can lead to neurologic symptoms and be life threatening.
This article discusses why hemorrhagic stroke happens, how to recognize it, and what treatments are available.
What causes a hemorrhagic stroke?
A hemorrhagic stroke is caused by bleeding in the brain. This can happen when a blood vessel in the brain bursts or when brain tissue starts to bleed. The damage from a hemorrhagic stroke can result from pressure caused by bleeding, edema, or a lack of blood supply.
Brain tissue can bleed after an ischemic stroke, which is a stroke caused by a blocked blood supply. This damages brain tissue, making it frail and prone to bleeding.
There is an especially high risk of a hemorrhagic stroke after a large ischemic stroke with extensive brain damage and tissue swelling. This is called a hemorrhagic conversion. It can happen anywhere from a few days to 2 weeks after an ischemic stroke.
Other common causes of hemorrhagic stroke include brain tumors, tumors that metastasize to the brain, and severe infections in the brain.
What percentage of strokes are hemorrhagic?
Researchers estimate that about 13% of stroke cases are hemorrhagic strokes.
There are different types of hemorrhagic stroke. An intracerebral hemorrhage is the most common type. In this type, bleeding occurs inside the brain. In a subarachnoid hemorrhage, bleeding occurs between the brain and the membranes that cover it.
Learn about different types of stroke.
Risk factors for stroke
The following conditions, medical histories, and habits may be associated with a higher risk of stroke:
- high blood pressure
- high levels of low-density lipoprotein (LDL) cholesterol
- family history of stroke
- history of heart disease, cardiovascular disease, or stroke
- high levels of stress and anxiety
- certain medical conditions, such as a bleeding disorder or sickle cell disease
- use of blood-thinning medication, such as warfarin (Coumadin)
- use of recreational drugs such as cocaine
- sedentary lifestyle
- lack of dietary variety and nutrition
- high alcohol consumption
- excess weight around the waist and abdomen
- cerebral amyloid angiopathy, in which proteins collect in the blood vessels in the brain, leading to damage and risk of tears
Risk factors for hemorrhagic stroke
Risk factors for intracerebral hemorrhage include blood vessel malformations such as:
- Cerebral cavernous malformation: This is when small blood vessels called capillaries collect in the brain, become enlarged and misshapen, and may affect blood flow.
- Cerebral aneurysm: This is a bulge in the wall of a blood vessel in the brain. An aneurysm can increase in size, causing the artery wall to weaken. If an aneurysm bursts, it may lead to uncontrolled bleeding.
- Arteriovenous malformation (AVM): This genetic condition typically affects the brain and spine. If it occurs in the brain, the blood vessels can break, leading to bleeding into the brain. This disorder is rare.
Risk factors specific to subarachnoid hemorrhage include:
- having a bleeding disorder
- experiencing a head injury and physical trauma
- using blood-thinning medication
According to a 2020 review, Black Americans, Hispanic Americans, and Native Americans all have a higher risk of stroke than white Americans for various socioeconomic and other reasons. The authors recommend improving access to healthcare to help reduce inequity.
Black Americans experience the highest stroke death rate of all racial groups. When it comes to hemorrhagic stroke specifically, Black Americans and Hispanic Americans have a higher risk of recurrence than white Americans.
Black and Hispanic women especially have a 6-fold risk of having a hemorrhagic stroke while giving birth compared to white women.
Symptoms of hemorrhagic stroke
Some of the most common symptoms of a stroke include:
- numbness or weakness in the arm, face, or leg
- sudden confusion
- difficulty speaking or understanding speech
- loss of balance or coordination
- sudden, severe headache
- difficulty seeing in one or both eyes
Recognizing the early symptoms of stroke is the best way to help a person get medical treatment quickly. The National Heart, Lung, and Blood Institute urges people to remember the acronym FAST:
- F = face: Does one side of the face droop when the person smiles?
- A = arms: When they lift both arms, does one arm drift down?
- S = speech: Is the person’s speech slurred?
- T = time: Call 911 immediately if the answer to any of the above is yes.
A hemorrhagic stroke shares many of the same symptoms as other types of stroke. However, it may also cause other symptoms, such as vomiting, neck stiffness, and increased blood pressure.
Subarachnoid hemorrhage may also cause seizures, loss of consciousness, sensitivity to light, and a sudden, severe headache, also known as a thunderclap headache.
Symptoms of a hemorrhagic stroke may start suddenly or develop over several days. A person may also experience:
- a sudden, severe headache or inability to look at bright light
- vision changes
- loss of balance or coordination
- numbness or weakness on one side of the body
- loss of speech or difficulty understanding speech
- confusion or loss of consciousness
- nausea and vomiting
- paralysis or numbness in any part of the body
- stiffness or pain in the neck area
- changes in heartbeat and breathing
Complications of hemorrhagic stroke
Depending on the extent of the damage, a person may experience a range of complications from a hemorrhagic stroke.
The neurological complications can include:
- muscle weakness
- decreased sensation
- thinking difficulties
- difficulty swallowing or talking
- loss of bladder or bowel control
- loss of vision
- mental health challenges, such as depression
Other complications include:
- a higher risk of pneumonia, if the person inhales food or drink
- brain swelling, which can occur within about a week after the stroke
- blood clots, which may lead to deep vein thrombosis and possibly pulmonary embolism
- urinary tract infections if the person has a catheter
- pressure sores if the person is unable to move unaided
- shoulder pain due to muscle weakness
Some of these complications will improve with time, and rehabilitation can help others. A person may need ongoing medical treatment to monitor and manage their symptoms.
Following a hemorrhagic stroke, a person may experience severe headaches for some time. A doctor will provide pain relief medication. Consuming caffeine and alcohol may make the headaches worse.
How to treat hemorrhagic stroke
Immediate treatment for hemorrhagic stroke is essential. Emergency treatment focuses on controlling bleeding and reducing pressure in the brain. This can involve repairing affected blood vessels or sealing an aneurysm.
A surgical procedure known as a craniotomy may be necessary if there is brain swelling. A surgeon will open a small section of the skull to help relieve pressure on the brain that is building up due to the bleeding.
A doctor may also prescribe medication to reduce blood pressure. This will lower pressure in the brain.
If the person usually takes blood thinners or other anti-clotting drugs, the doctor may give medication to counter their effects.
Blood sugar levels should also be closely regulated, as both high and low blood sugar can worsen outcomes for a hemorrhagic stroke.
Additionally, a doctor will not recommend the intravenous administration of recombinant tissue plasminogen activator (rtPA), which is a type of medication used to break up blood clots. This medication could worsen bleeding.
Following emergency treatment, the individual will likely have a program of rehabilitation. This can help them:
- regain strength
- recover as much function as possible
- return to independent living
The extent of recovery will depend on the area of the brain affected and the amount of tissue damage.
Tips that may help include:
- following a heart-healthy diet
- avoiding or quitting smoking
- developing a plan for regular exercise, in consultation with a health professional
- managing body weight, if appropriate
- developing regular sleeping habits, if possible
- following the treatment plan, including taking medications and attending follow-up appointments
- asking about rehabilitation to help with speech, movement, and other challenges
- seeking support from loved ones and healthcare professionals to manage mental health
- monitoring for new or worsening symptoms and complications and seeking help if they occur
A doctor will help the individual determine the best rehabilitation program for them, depending on their age, their overall health, and the impact of the stroke.
Some people may need speech, physical, and occupational therapy. Therapy and medication may also help manage any impact on mental health, such as depression.
Hemorrhagic stroke outlook
It can take time to recover from a stroke, and some people never recover fully. They may need long-term treatment and supportive care.
According to a 2020 study, only about 34% of people who experienced a hemorrhagic stroke survived past the first year.
However, the impact will depend on where the damage occurs, how severe it is, and how quickly a person receives treatment. While many people need ongoing care, researchers estimate that around 12–39% of people are able to achieve long-term functional independence.
A person who has had a stroke may also have a higher risk of having another one. According to the Centers for Disease Control and Prevention (CDC), 1 in 4 strokes that happen each year in the United States affect people who have had a stroke before.
Diagnosing hemorrhagic stroke
To diagnose a stroke, a doctor will likely:
- consider the person’s symptoms
- look at their medical history
- carry out a physical examination
- do some imaging tests
- carry out other tests
During the physical exam, a doctor will assess:
- mental alertness
- signs of numbness or weakness in the face
Imaging tests, such as a CT or MRI scan, can show if there is bleeding inside the brain. This can help identify the type of stroke. An electroencephalogram (EEG) gives information about brain function.
The doctor may also recommend blood tests and a lumbar puncture.
Preventing hemorrhagic stroke
It is not always possible to prevent a stroke, but some lifestyle changes may help.
- quitting or avoiding smoking
- maintaining a healthy weight
- exercising regularly
- following a healthy and varied diet
- having regular health checks
- taking action to manage heart disease, diabetes, and other conditions
These preventive measures are especially important for people who have already had a stroke.
Hemorrhagic stroke in children
Strokes usually affect older people, but they can also occur in children. Approximately 44% of strokes in children are hemorrhagic, compared to 13% in adults.
Possible causes of stroke in children include:
- blood vessel problems that are present at birth
- conditions that affect the blood, such as sickle cell disease
- some metabolic disorders
If a child has a hemorrhagic stroke, the symptoms most likely to appear are:
- weakness on one side of the body
- reduction or loss of consciousness
- difficulty speaking
- difficulty seeing
There may also be a fever before other symptoms appear.
Sometimes, an infant experiences a stroke soon after birth, but the symptoms may not be apparent, or they may resemble those of another condition. In some cases, the effects only become apparent as the child develops. The child may show signs of weakness, speech difficulties, and other symptoms, such as headaches.
Emergency treatment will aim to manage symptoms and reduce the risk of complications. This may include measures to reduce pressure in the brain and prevent dehydration.
The long-term impact will depend on the location and severity of the stroke. It can affect the individual’s physical and emotional health and ability to learn and socialize.
Long-term treatment, such as physical and speech therapy, can help.
Overall, the chance of surviving a stroke appears to be higher among children than adults. If the child has another condition, such as a heart problem, it may affect their outlook.
Questions and answers
What causes hemorrhagic stroke?
Hemorrhagic stroke most often occurs when a blood vessel in the brain leaks or ruptures, which is known as a hemorrhagic conversion of an ischemic stroke or a bleeding brain tumor. Other causes include severe brain infection, head trauma, certain bleeding disorders, or an aneurysm.
How is hemorrhagic stroke treated?
Treatment for a hemorrhagic stroke can vary depending on the cause, location, and severity. Generally, treatment focuses on controlling bleeding and relieving pressure on the brain using either medications or surgery.
Can a person survive a hemorrhagic stroke?
According to one study, about 34% of people who experienced a hemorrhagic stroke survived past the first year. However, the chances of survival depend on the severity of the stroke and how quickly a person is able to receive treatment.
How long can a person live after a hemorrhagic stroke?
Recovery from a stroke can be a long process, and approximately 1 in 4 people who survive a stroke have another within 5 years.
Fortunately, researchers estimate that around 12–39% of those who survive an intracerebral hemorrhage are able to achieve long-term functional independence.
Identifying and treating the underlying causes of a stroke may help improve outcomes and reduce the risk of recurrence.
Hemorrhagic stroke vs. hemorrhagic shock: Are they the same?
Although hemorrhagic stroke and hemorrhagic shock may sound similar, they are not the same condition. They both include the term “hemorrhagic” because they both involve excessive bleeding.
However, hemorrhagic stroke is a stroke that occurs due to bleeding in the brain, whereas hemorrhagic shock is a major loss of fluid volume in the body as a result of blood loss. Hemorrhagic shock is a type of hypovolemic shock.
A hemorrhagic stroke is a stroke that involves bleeding in the brain. It is potentially life threatening and needs immediate medical attention.
It is not always possible to prevent a hemorrhagic stroke, but avoiding smoking, getting regular exercise, and following a nutritious diet may help.