Ischemic vs. hemorrhagic stroke: What is the difference?

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Ischemic and hemorrhagic strokes have different causes.

Ischemic stroke

A blockage or clot in a blood vessel that leads to part of the brain may cause an ischemic stroke. In many cases, atherosclerosis can contribute to an ischemic stroke. Atherosclerosis refers to a buildup of fatty deposits around the inside walls of arteries.

There are two types of ischemic stroke:

• Thrombotic strokes: These occur when blood begins to clot in a blood vessel leading to a part of the brain. A person may experience a transient ischemic attack, or ministroke, before they experience a major thrombotic stroke.
• Embolic strokes: These occur when a blood clot from another part of the body reaches a part of the brain and gets stuck in a blood vessel there.

Learn more about the difference between thrombosis and embolism here.

Hemorrhagic stroke

During a hemorrhagic stroke, a blood vessel in part of the brain ruptures or leaks and releases blood into the surrounding areas of the brain. The pooling blood puts pressure on the brain cells in the area and can cause them to die.

Additionally, the area of the brain that usually receives blood from the ruptured blood vessel may not receive an adequate supply.

There are two main types of hemorrhagic stroke: intracerebral hemorrhage and subarachnoid hemorrhage. During an intracerebral hemorrhage, bleeding occurs from blood vessels within the brain, possibly due to high blood pressure.

During a subarachnoid hemorrhage, bleeding occurs in the subarachnoid space, which is the space between the brain and the membranes that cover it. The causes of a subarachnoid hemorrhage include:

• A cerebral aneurysm: This occurs when a weakened area in a blood vessel enlarges, making it more likely to rupture.
• An arteriovenous malformation: This refers to a tangle of blood vessels in the brain that directly diverts blood from the arteries to the veins instead of into the brain tissue.
• Trauma: In some cases, a traumatic brain injury may cause a subarachnoid hemorrhage.

The signs and symptoms of ischemic and hemorrhagic strokes are similar as they both reduce blood flow to part of the brain.

Symptoms of a stroke can vary between people. However, they typically occur suddenly. When someone is having a stroke, they may experience sudden:

• numbness or weakness on one side of the body or face
• difficulty speaking or understanding speech
• confusion
• difficulty walking, lack of coordination, or loss of balance
• dizziness
• severe headache

Learn more about the FAST signs of stroke here.

Before a person receives any stroke treatment, healthcare professionals need to know which type of stroke a person is experiencing. Doctors typically diagnose the type of stroke based on a person’s symptoms and medical history, in addition to a physical exam and diagnostic tests.

A healthcare professional may conduct tests including:

• CT or MRI scans
• other types of imaging tests
• blood tests
• an electrocardiogram
• a lumbar puncture

Doctors aim to make a swift diagnosis of stroke so they can start treatment as soon as possible. The longer a person goes without treatment, the higher their risk of experiencing long-term brain damage.

The treatment of ischemic and hemorrhagic strokes differs.

Ischemic stroke

If a person gets to a hospital within 3 hours of the stroke starting, they may receive a thrombolytic drug, such as a tissue plasminogen activator. This type of medication aims to dissolve or break up the clot so that blood can flow freely into the brain.

In other instances, when a person does not get to the hospital within 3 hours of the stroke occurring, they may receive other blood thinners or undergo clot removal surgery. A healthcare professional will determine the best course of treatment after diagnosis.

Hemorrhagic stroke

When treating a hemorrhagic stroke, the healthcare professional’s main aim is to stop the bleeding. Doctors may do this with the following:

• Endovascular procedures: These procedures are less invasive than surgical treatment and help repair weak spots in blood vessels.
• Surgical treatment: A surgeon may use a metal clip to seal the blood vessel and stop blood loss.
• Medications: A doctor may administer medications to lower blood pressure, such as beta-blockers.

A person may be able to reduce their risk of stroke by following treatment guidelines for any underlying heart conditions and keeping the following within the recommended ranges:

• blood pressure
• glucose levels
• cholesterol levels

It may help to make lifestyle changes, such as:

• quitting smoking, if applicable
• maintaining a moderate weight
• exercising regularly
• eating a healthy diet

Ischemic and hemorrhagic strokes have different causes. When a blood clot or other debris blocks a blood vessel leading to part of the brain, it causes an ischemic stroke. Hemorrhagic strokes occur due to ruptured blood vessels in an area of the brain.

Symptoms of ischemic and hemorrhagic strokes are similar and may include numbness and weakness down one side of the body, confusion, and headache.

Treatment of strokes depends on the cause. Healthcare professionals may use thrombolytic drugs to dissolve a clot that is causing a stroke. When this is not possible, a person may receive blood thinners or undergo surgery. For hemorrhagic strokes, a doctor may need to perform surgery to stop the bleeding.

Lifestyle changes such as keeping active and eating a healthy diet may help reduce the risk of stroke. It is best for a person to speak with a doctor for further information about their individual risk of experiencing a stroke.