A hemorrhagic stroke can happen when blood from an artery begins bleeding into the brain after a blood vessel bursts.

Doctors may also use the term intracranial stroke when talking about hemorrhagic stroke.

The bleeding puts pressure on surrounding brain cells, damaging them. The damaged area becomes unable to function properly. This can lead to neurologic symptoms. It can be life-threatening.

In this article, find out why a hemorrhagic stroke happens, how to recognize it and what treatments are available.

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A hemorrhagic stroke happens when a blood vessel bursts, causing bleeding in the brain. As the blood presses on brain cells, it damages them. This can lead to neurological symptoms.

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.

What other types of stroke are there?

The following conditions, medical histories and habits may put a person at a higher risk of a stroke:

AVMs typically occur in the brain and spine. If they occur in the brain, the vessels can break, leading to bleeding into the brain. This disorder is rare.

Risk factors specific to hemorrhagic stroke

Additional risk factors for intracerebral hemorrhage include blood vessels not forming correctly in the brain, known as cerebral cavernous malfunctions.

Risk factors specific to subarachnoid hemorrhage include:

  • having a bleeding disorder
  • experience a head injury and physical trauma
  • using blood-thinning medication
  • a bulge in the wall of a blood vessel, called a cerebral aneurysm

An aneurysm can increase in size, causing the artery wall to weaken. If an aneurysm bursts, uncontrolled bleeding may occur.

Health inequity

An older study, published in 2008, notes that Black Americans, Hispanic Americans, and Native Americans all have a higher risk of stroke than white Americans for various socio-economic and other reasons.

The authors recommend improving access to healthcare to help reduce inequity.

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 urge 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 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.

Symptoms of a hemorrhagic stroke may start suddenly or develop over several days. A person may experience:

  • a sudden, severe headache
  • vision changes
  • loss of balance or coordination
  • becoming unable to move
  • numbness or weakness on one side of the body
  • seizures
  • loss of speech or difficulty understanding speech
  • confusion or loss of alertness
  • nausea and vomiting
  • loss of consciousness
  • paralysis or numbness in any part of the body
  • inability to look at bright light
  • stiffness or pain in the neck area
  • changes in heartbeat and breathing
  • difficulty swallowing

Complications

Depending on the extent of the damage, a person may experience a range of complications from a hemorrhagic stroke.

They include:

  • blood clots that may lead to deep vein thrombosis and possibly a pulmonary embolism
  • muscle weakness
  • inability to move
  • difficulty swallowing or talking
  • loss of bladder or bowel control
  • memory loss or thinking difficulties
  • loss of vision, hearing, or the sense of touch
  • a higher risk of pneumonia, if the person inhales food or drink
  • brain swelling that may need further treatment
  • seizures
  • mental health challenges, such as depression
  • a reduction in bone density
  • 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 will improve with time, and rehabilitation can help with 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. Caffeine and alcohol use may make the headaches worse.

Some people report a strange feeling like tickling in the brain. This usually resolves with time.

Immediate treatment for hemorrhagic stroke is essential. Emergency treatment focuses on controlling bleeding and reducing pressure in the brain.

Surgery known as a craniotomy may be necessary. A surgeon will open a small section of the skull to prevent further bleeding. They may need to repair blood vessels or seal an aneurysm.

A doctor may 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 impact.

Rehabilitation

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
  • as far as possible, developing regular sleeping habits
  • following the treatment plan, including medications and follow-up appointments
  • asking about rehabilitation to help with speech, movement, and other challenges
  • seeking support from loved ones and healthcare providers 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, overall health, and the impact of the stroke.

Some people may need speech, physical, and occupational therapy. Therapy and medicine may also help manage any impact on the person’s mental health, such as depression.

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 research article published in 2011, 51–61% of people who experience an intracerebral hemorrhage do not survive the first year. Around half of these fatalities occur within 2 days of the stroke.

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, around 20% can look after themselves independently after 6 months.

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.

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
  • coordination
  • balance
  • signs of numbness or weakness in the face
  • confusion
  • speech

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.

It is not always possible to prevent a stroke, but some lifestyle choices may help.

These include

  • quitting or avoiding smoking
  • maintaining a healthy weight
  • exercising regularly
  • following a healthful and varied diet
  • having regular health checks
  • taking action to manage heart disease, diabetes, and other conditions

These measures are especially important for people who have already had a stroke, to prevent another one.

Strokes usually affect older people, but they can also occur in children. Around half of strokes in children are hemorrhagic, compared with 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
  • infections
  • trauma
  • cancer
  • drug use
  • some metabolic disorders

If a child has a hemorrhagic stroke, the symptoms most likely to appear are:

  • weakness on one side of the body
  • headache
  • vomiting
  • reduction or loss of consciousness
  • seizures
  • difficulty speaking
  • sleepiness
  • 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. They may show signs of weakness, lethargy, apnea, speech difficulties, and other symptoms, such as headaches, that may last only a short time.

Some children may experience repeated strokes, some of which may be transient, which means they pass quickly.

Emergency treatment will aim to manage symptoms and reduce the risk of complications. This may include measures to reduce pressure in the brain and preventing 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 their 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 in adults. If the child has another condition, such as a heart problem, this may affect their outlook.

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 healthful diet may help.