Hemorrhagic Stroke

What is a hemorrhagic stroke?

A hemorrhagic stroke is a life-threatening emergency that happens when a blood vessel in your brain breaks (ruptures) and bleeds. A “hemorrhage” is the medical term for bleeding inside your body.

The bleeding disrupts normal circulation in your brain and prevents it from getting the blood and oxygen it needs to survive and function. The stroke also adds extra pressure inside your brain, which can damage or kill brain cells.

Hemorrhagic (pronounced “hem-or-AJ-ICK”) strokes are particularly dangerous because they cause severe symptoms that get worse quickly. Without fast medical attention, these strokes often cause permanent brain damage and can be fatal.

If you think you or someone you’re with is having a stroke, immediately call 911 (or your local emergency services number). The sooner someone is diagnosed and treated, the more likely it is they’ll survive a stroke. Every second counts.

What are hemorrhagic stroke symptoms?

The symptoms of a hemorrhagic stroke can include one or more of the following:

• Thunderclap headaches
• Light sensitivity (photophobia)
• Dizziness or vertigo
• Trouble understanding or speaking (aphasia)
• Slurred or garbled speaking (dysarthria)
• One-sided weakness or paralysis
• Loss of senses, like vision, hearing and touch
• Neck stiffness
• Nausea and vomiting
• Seizures
• Passing out or fainting
• Coma

What are the warning signs of a hemorrhagic stroke?

Hemorrhagic strokes can cause lots of different symptoms. To recognize the warning signs in yourself or a loved one, remember the acronym BE FAST:

• Balance: Watch for a sudden loss of balance.
• Eyes: Look out for sudden vision loss or changes in one or both eyes.
• Face: Smile. Look for a droop on one or both sides of your face.
• Arms: Raise both arms. If you’re having a stroke, one arm may not move, sag or be very weak.
• Speech: You might slur your speech or have trouble choosing the right words.
• Time: Time is critical — call for help immediately. If possible, look at your watch, phone or a clock to track when symptoms start. Telling a healthcare provider when symptoms began can help them know which treatments are best for you.

Transient ischemic attack

A transient ischemic attack (TIA) — sometimes called a “mini-stroke” — is like a stroke, but the effects are temporary. These are often warning signs that a person has a very high risk of having a true stroke soon. A person who has a TIA needs emergency medical care as soon as possible.

What causes hemorrhagic strokes?

Anything that damages or breaks blood vessels in your brain can cause a hemorrhagic stroke. Having high blood pressure (hypertension) is the most common cause. That’s especially true if your blood pressure is very high or stays high for a long time.

Other conditions that can cause a hemorrhagic stroke include:

• Brain aneurysms
• Brain tumors
• Moyamoya disease
• Cerebral amyloid angiopathy
• Head injuries
• COVID-19
• Ischemic strokes that cause bleeding during or after the stroke

Types of hemorrhagic strokes

Hemorrhagic stroke can happen in one of two ways:

• Bleeding inside your brain (intracerebral hemorrhage): When a blood vessel inside your brain ruptures it puts pressure on the brain tissue from the inside.
• Bleeding into the space between your brain and its outer covering (subarachnoid hemorrhage): Your brain is surrounded by a thin, protective layer called the arachnoid membrane. The space between that membrane and your brain is the subarachnoid space. If any blood vessels that pass through the arachnoid membrane break, bleeding can fill up the subarachnoid space. That causes pressure inside your skull pressing on your brain from outside it.

What are the risk factors?

Anyone can experience a hemorrhagic stroke, but you have a higher risk if you:

• Are older than 65
• Smoke (or use other forms of tobacco)
• Use recreational or nonprescription drugs

You may have a higher stroke risk if you have a health condition that affects your circulatory system, including:

• High blood pressure (hypertension)
• Alcohol use disorder
• High cholesterol (hyperlipidemia)
• Migraine headaches (especially migraines with auras)
• Diabetes

How are hemorrhagic strokes diagnosed?

A healthcare provider will diagnose a hemorrhagic stroke with a neurological exam and tests, including:

• CT scan
• Blood tests
• Electrocardiogram (EKG)
• MRI

What are the two main treatments for hemorrhagic strokes?

The two main treatments for hemorrhagic strokes are medications and surgery.

Hemorrhagic stroke medications

There are many medications that providers use to treat hemorrhagic strokes. They work in one of two ways:

• Clotting support: Many people think clotting in your blood is only a bad thing (and blood clots can be very dangerous). But clotting is your body’s natural way to stop bleeding. Your providers might give you medications like vitamin K therapy or prothrombin complex concentrate to increase your body’s ability to stop the bleeding in your brain.
• Blood pressure management: Keeping your blood pressure at a safe level can slow the brain bleed. It can also help your blood safely clot and seal the damaged blood vessel. Your provider may start you on an intravenous (IV) blood pressure medication to keep your blood pressure in a safe range.

Hemorrhagic stroke surgery

Accumulated blood from a stroke puts too much pressure on brain tissue around the bleeding blood vessel. You might need emergency surgery if the stroke increases your intracranial pressure. Your surgeon will remove the extra blood and relieve the pressure buildup on your brain.

Stroke rehabilitation

Stroke rehab is an important part of treating a hemorrhagic stroke. You’ll need rehab to help you adjust to changes in your brain and body. You might need to regain abilities or adjust to new or different disabilities. You might need a combination of:

• Speech therapy to regain or improve your language and speaking abilities. It can help you control the muscles that help you talk, breathe, eat and swallow.
• Physical therapy to strengthen your muscles, improve your balance and regain use of your arms and legs.
• Occupational therapy to help you safely complete your daily tasks, especially chores or activities that need precise body movements.
• Cognitive therapy to help improve your memory, concentration and other mental abilities.

How can I prevent a hemorrhagic stroke?

Maintaining a healthy blood pressure level is the most important way to prevent a hemorrhagic stroke. If you have high blood pressure, your healthcare provider can help you manage it. They’ll suggest medications and changes to your daily routine that can keep your blood pressure in a safe range.

Other things you can do to reduce your risk of having a hemorrhagic stroke include:

• Managing other health conditions you may have.
• Eating plenty of healthy foods and maintaining a weight that’s healthy for you.
• Getting plenty of physical activity.
• Visiting a healthcare provider for checkups every year (or as often as they suggest).
• Stopping smoking.

What is the life expectancy after a hemorrhagic stroke?

It’s hard for experts to estimate a life expectancy or survival rate for hemorrhagic strokes. That’s because everyone’s body and health are unique.

Strokes can be fatal, and they can cause permanent disabilities. But there’s no one standard recovery timeline or outlook that’s accurate for everyone.

Hemorrhagic strokes are more likely to be fatal than ischemic strokes. But that doesn’t mean you’ll definitely have a worse outcome than any other person.

Everyone’s body responds differently to a stroke. What you can expect (the prognosis) after a stroke depends on a few factors, including:

• Which areas of your brain it affected.
• How quickly it was treated.
• Your overall health.

Your provider will tell you what to expect. They’ll help you set recovery goals and expectations that fit your unique health and situation.

How do I take care of myself after a hemorrhagic stroke?

Recovering and rehabbing after a stroke is hard work. Once you and your provider finalize your treatment plan, follow it as closely as possible. In general, you should:

• Take your medications: Taking your medicine as often as your provider suggests will help your body heal. Managing your blood pressure is extremely important.
• Go to your rehab and other therapy appointments: Tell your therapists if anything makes you feel unsafe or uncomfortable. Rehab is hard work, but you shouldn’t be in constant pain or discomfort.
• Remember your mental health: Depression and anxiety are extremely common after a stroke. You’re not weak or a quitter for feeling sad or upset. Your emotional health can be just as important as how your physical body is doing. Talk to your provider or a mental health professional if you feel like you need help processing anything during your recovery.

When should I go to the emergency room?

Call 911 (or your local emergency services number) if you think you’re experiencing stroke symptoms again. Another stroke has an even higher risk of being fatal or causing severe complications. Don’t wait to call for help.

People who’ve had a stroke have an increased risk of other potentially serious complications, including:

• Pulmonary embolism.
• Heart attack.
• Deep vein thrombosis (DVT).

Call emergency services or go to the ER if you think you’re experiencing any symptoms of these complications.

Which questions should I ask my healthcare provider?

• How do I take my medication?
• How long will I need therapy?
• Which changes to my daily routine will I need to make?
• Which signs or symptoms of another stroke should I watch out for?
• When should I follow up with you?