What Is a Hemorrhagic Stroke?

Hemorrhagic strokes cause bleeding in the brain. They happen when a blood vessel in the brain bursts, similar to a pipe bursting. This can occur due to conditions like an aneurysm, arteriovenous malformation, moya moya disease, or high blood pressure. Hemorrhagic strokes make up about 15% of all strokes and are often more deadly than ischemic strokes. Immediate treatment is crucial to prevent brain damage or death.

Types of Hemorrhagic Stroke

There are two subtypes of hemorrhagic stroke based on where the brain bleeding occurs:

• Intracerebral: Bleeding occurs within the brain substance.
• Subarachnoid: Bleeding occurs between the brain and the membrane surrounding it, where arteries live.

Both types of hemorrhagic strokes put pressure on the brain. The severity often depends on what bursts, such as a vein or artery, and where it bursts, such as within the brain tissue (intracerebral hemorrhage) or in the space around the brain (subarachnoid hemorrhage).

Brain Bleed or Stroke?

"Hemorrhage" is the medical term for bleeding due to a ruptured blood vessel. Hemorrhagic strokes are a type of brain bleed and are considered strokes. Although we often use the word "stroke" to refer specifically to ischemic strokes, where an artery closes and the brain doesn’t get enough blood, both hemorrhagic and ischemic events are types of strokes. A stroke is a sudden, often catastrophic, neurological event.

Hemorrhagic Stroke Symptoms

Stroke symptoms vary. Depending on the location of the stroke, it will affect different parts of the brain.   The most common symptom of hemorrhagic stroke is severe, sudden headache. Otherwise, many common hemorrhagic stroke symptoms are shared with other types of strokes, including:

• Loss of senses (vision, hearing, smell, touch) on one side of the body
• Difficulty communicating (slurred speech or inability to speak)
• Muscle weakness or facial drooping on one side
• Clumsiness or reduced coordination
• Neck stiffness
• Confusion, difficulty understanding, or memory loss
• Sudden, severe headaches
• Vision problems

Learn more about stroke causes and symptoms.

What Causes Hemorrhagic Stroke?

A hemorrhagic stroke is caused by bleeding in the brain or the area around the brain. This bleeding usually occurs when a blood vessel breaks open, spilling blood. Several conditions can lead to such breaks, including:

• Brain aneurysm: An aneurysm is a weak area in an artery that can grow and sometimes burst, leading to blood spilling out and putting pressure on the brain, usually in the subarachnoid space. About half of ruptured aneurysms can lead to death.
• Arteriovenous malformation (AVM): An AVM is a misconnection between an artery and a vein. Normally, blood flows from an artery to capillaries, which slow the blood down and allow it to be used by the body, before moving into a vein at low pressure. However, when capillaries are missing, the high pressure from the artery goes directly into the softer, less strong veins, leading to wear, tear, and bleeding. AVM bleeding is a leading cause of hemorrhagic stroke in people under 45.
• Moya moya disease: Moya moya disease can lead to bleeding. This condition occurs when the arteries at the base of the brain slowly become occluded, putting strain on other, more fragile arteries. It's similar to a blocked highway causing back roads to get too much traffic. This increased pressure can lead to bleeding.
• High blood pressure: Hypertension is a common cause of hemorrhagic stroke, especially after the age of 55. It is one of the most preventable causes of stroke, and taking antihypertensive medication can help manage high blood pressure and reduce the risk.
• Acute trauma: Sometimes as a head injury, trauma can lead to bleeding in the brain, but we don’t typically refer to this as a stroke.

How to Avoid Hemorrhagic Stroke

There's no way to guarantee that you won't have a hemorrhagic stroke, but lifestyle factors can make it less likely.

High blood pressure is the primary risk factor for hemorrhagic strokes, and maintaining healthy blood pressure levels helps prevent hemorrhagic strokes. Other lifestyle risk factors to avoid include:

• Smoking/tobacco use
• Illegal drug use
• Excessive alcohol consumption
• An unhealthy diet
• High cholesterol
• Obesity

Additionally, adopting healthy habits can reduce stroke risk, such as:

• Regular exercise
• Good sleep hygiene
• Managing chronic stress

In addition to lifestyle factors, some medical conditions—like Type 2 diabetes and chronic liver disease—can increase your risk of hemorrhagic stroke. Ask your doctor about the risk posed by any other medical conditions you have.

Complications of Hemorrhagic Stroke

Hemorrhagic strokes are often deadly. Survivors may suffer physical, psychological, and neurological complications. The extent of your complications and the possibility of recovery depend on the location and severity of the damage caused by your stroke. Complications include:

• Loss of motor skills, especially on one side of the body
• Difficulty speaking
• Seizures
• Memory loss
• Weakness
• Depression
• Other cardiovascular problems, such as deep vein thrombosis, pulmonary embolism, and heart attack

Unfortunately, stroke survivors are also at an increased risk of stroke. If you've had a stroke already, be especially careful to manage risk factors.

Quality of Life After Hemorrhagic Stroke

The effect on your quality of life will depend on the severity of your stroke. Age is a factor, with older survivors usually suffering more significant drops in quality of life. It's common for stroke survivors to suffer depression and anxiety, so taking care of your psychological health is crucial for maximizing quality of life after hemorrhagic stroke.

After a hemorrhagic stroke, you'll usually spend several days to a week in the hospital. As you recover, you'll be prescribed physical therapy, speech therapy, and cognitive therapy to help you regain your abilities. Our goal is to prevent you from ever experiencing another hemorrhagic stroke.

Diagnosis of Hemorrhagic Stroke

Hemorrhagic stroke is a life-threatening emergency that progresses quickly, so fast diagnosis is vital. If you suspect someone is having a stroke, the FAST method can help you evaluate them on the spot:

• Face: Ask the person to smile and look for facial drooping, a sign of paralysis or muscle weakness.
• Arms: Can the person raise both arms equally well? If not, it may be a sign of hemorrhagic stroke.
• Speech: Get the person to repeat some simple phrases. If they struggle to do so or if their replies are slurred or confused, it may indicate a stroke.
• Time: Getting help immediately is the priority. Call 911 and request an ambulance.

FAST helps identify the need to call an ambulance, but only a doctor can diagnose a hemorrhagic stroke. When you get to the hospital, a specialized neurologist will perform an exam and request medical imaging.

A CT scan for hemorrhagic stroke can show the location of the bleeding and help the care team determine the best method of treatment.

What Are Treatments for Hemorrhagic Stroke?

When treating hemorrhagic stroke, the priorities are stopping the bleeding and relieving pressure on the brain. Unfortunately, it can be challenging to treat the bleeding directly since the area where the blood vessel ruptured is often hard to reach.

If they can't stop the bleeding directly, doctors may use medications that encourage blood clotting to slow or stop the hemorrhage. They'll also try to lower your blood pressure and reduce swelling since brain swelling can put even more pressure on the affected areas.

Hemorrhagic Stroke Surgery

In some cases, doctors may perform surgery to relieve pressure or stop the bleeding. They may also reduce the aneurysm or redirect blood flow to healthy blood vessels. These procedures can reduce the chance of future strokes. We can often address the underlying cause of a hemorrhagic stroke, such as removing an AVM, repairing an aneurysm, or bypassing the affected arteries in moya moya disease.

FAQs About Hemorrhagic Stroke