A stroke occurs when blood flow to an area of the brain is cut off. When this happens the brain cells are deprived of oxygen and begin to die.
A hemorrhagic stroke is when blood from an artery begins bleeding into the brain. This happens when a weakened blood vessel bursts and bleeds into the surrounding brain.
Pressure from the leaked blood damages brains cells, and, as a result, the damaged area is unable to function properly.
There are two main types of hemorrhagic stroke:
- Intracerebral hemorrhage: The bleeding occurs inside of the brain. This is the most common type of hemorrhagic stroke.
- Subarachnoid hemorrhage: The bleeding occurs between the brain and the membranes that cover it.
Both types of hemorrhagic stroke have the conventional stroke risk factors.
In addition, the risk factors for intracerebral hemorrhage include:
- Hypertension - the most common cause.
- Cerebral cavernous malfunctions - when blood vessels do not form correctly in the brain.
- Arteriovenous malformations (AVMs) - a genetic condition where blood vessels form incorrectly, leading to an abnormally tangled web.
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 for subarachnoid hemorrhage are most often:
- bleeding disorders
- head injury and trauma
- 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.
Symptoms of a hemorrhagic stroke can vary, but common signs include:
- sudden severe headache
- vision changes
- loss of balance or coordination
- becoming unable to move
- numbness in an arm or leg
- loss of speech or difficulty understanding speech
- confusion or loss of alertness
- nausea and vomiting
- loss of consciousness
Additional symptoms of either type of hemorrhagic stroke include:
- paralysis or numbness in any part of the body
- inability to look at bright light
- stiffness or pain in the neck area
- hand tremors
- frequent fluctuation in the heartbeat and breathing
- difficulty swallowing
In addition to other medical problems, a stroke can cause temporary or permanent disability. This depends on how long blood flow to the brain was interrupted and which part of the brain was affected.
Possible complications include:
To diagnose a hemorrhagic stroke, a thorough medical history and physical exam is usually necessary.
During the physical exam, a doctor will look for visible signs and symptoms. They will check a person's mental alertness, coordination, and balance. Numbness or weakness in the face, confusion, and trouble talking, are other signs doctors will look for.
As there are several different types of stroke, imaging tests must be done to find out if there is bleeding inside the brain. For hemorrhagic strokes, computed tomography (CT) scans are often the fastest and one of the most useful tests.
Other tests include:
- magnetic resonance imaging (MRI)
- blood tests
- MRI angiography, where dye is injected into the brain
An electroencephalogram (EEG) or lumbar puncture (spinal tap) can be done to confirm the diagnosis of a hemorrhagic stroke.
Hemorrhagic strokes are dangerous and are a medical emergency. According to the National Stroke Association, only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths.
Immediate treatment can be the difference between life and death. Emergency treatment focuses on controlling the bleeding as well as reducing the pressure in the brain.
A person taking blood thinners or similar drugs may be given medicine to help counteract their effects. Doctors often prescribe drugs to lower blood pressure and pressure in the brain, as well as to prevent the blood vessels from tightening and seizures.
Once bleeding has stopped, surgery may be an option to help prevent a hemorrhage from happening again. Surgery can also repair blood vessel abnormalities associated with hemorrhagic strokes. An aneurysm may be repaired with a surgical clip.
Once a person is out of immediate danger, the next phase of treatment focuses on rehabilitation. The aim is to help them regain strength, recover as much function as possible, and return to independent living.
The extent of recovery depends on the area of the brain and amount of tissue damaged by the stroke.
A doctor will determine the best rehabilitation program for each individual. They will take into account the person's age, overall health, and the degree of disability from the stroke.
Treatment may include speech, physical, and occupational therapy. Therapy and medicine may also be used to help with depression and to monitor a person's mental health.
According to the National Stroke Association, the risk of stroke increases with age. After the age of 55, stroke risk doubles for every decade a person is alive.
Although strokes typically affect older people, they can also affect children and teenagers. Hemorrhagic strokes in children have the same causes as in adults. Often children are born with the blood vessel problems that can lead to hemorrhagic stroke.
The National Stroke Association say that although children can be affected at any age, their greatest risk of stroke is during two periods:
- the first year of life
- the period right before and right after birth
It is harder to diagnose and treat newborns and children as most people do not think of them as having strokes. According to the Child Neurology Foundation, the most common type of hemorrhagic stroke is an intracerebral hemorrhage.
Most strokes in children cause a sudden onset of neurological problems such as weakness of one side of the body, trouble with balance, and difficulty speaking. Treatment options for children are very similar to those for adults.
The long-term effects of a hemorrhagic stroke in a child depend on the location and severity of the stroke. Some children experience lasting effects, such as seizures, when more long-term treatment is often needed.
Some problems, such as learning and speech difficulties, may only be evident over time. Physical and speech therapy are standard treatments.
Children tend to recover more quickly from stroke than adults because their brains are still growing. Consequently, they have a better chance of returning to a normal lifestyle sooner.
Hemorrhagic strokes can be prevented in some cases. According to the Centers for Disease Control and Prevention (CDC), 1 in 4 strokes each year are recurrent.
Understanding the risk factors and preventive measures are crucial. Those people at higher risk include smokers and those with one or more of the following:
- high blood pressure or high cholesterol
- being overweight
- a family history of stroke
- heart disease or disorder
Women and African Americans are at an increased risk of stroke. According to the National Stroke Association, African Americans have twice the risk mostly because they are more prone than others to high blood pressure, diabetes, and obesity.
Preventive measures include practicing a heart-healthy lifestyle, which includes:
- avoiding tobacco products
- staying within a healthy weight
- making heart-healthy eating choices
- managing stress properly
People should always seek medical care as soon as any of the symptoms of a hemorrhagic stroke are suspected.