Hemorrhagic Stroke

What is a hemorrhagic stroke?

A hemorrhagic (pronounced “hem-or-aj-ick”) stroke is a life-threatening medical condition that happens when a blood vessel in your brain ruptures and bleeds. This can disrupt the normal circulation of blood in your brain, starving some areas of oxygen. Accumulated blood also puts pressure on surrounding brain areas, damaging or destroying them.

Hemorrhagic strokes are particularly dangerous because they cause severe symptoms that get worse quickly. Without fast medical attention, these strokes often cause permanent brain damage or even death.

IMPORTANT: A stroke is a life-threatening emergency condition where every second counts. If you or someone with you has symptoms of a stroke, you need to IMMEDIATELY call 911 (or your local emergency services number). The longer it takes to receive care, the more likely a stroke will cause permanent brain damage or death.

To recognize the warning signs of a stroke, remember to think FAST:

• F is for face. Ask the person to smile. Look for a droop on one or both sides of their face, which is a sign of muscle weakness or paralysis.
• A is for arm. A person having a stroke often has muscle weakness on one side. Ask them to raise their arms. If they have one-sided weakness (and didn’t have it before), one arm will stay higher while the other will sag and drop downward.
• S is for speech. Strokes often cause a person to lose their ability to speak. They might slur their speech or have trouble choosing the right words.
• T is for time. Time is critical, so don’t wait to get help! If possible, look at your watch or a clock and remember when symptoms start. Telling a healthcare provider when symptoms started can help the provider know what treatment options are best for you.

Who does it affect?

Hemorrhagic strokes are most common in people with diseases that affect their circulatory system, which includes the heart and blood vessels. Problems like these are more common as people get older, so these kinds of strokes are more common later in life.

About two-thirds of all strokes happen to people over the age of 65. However, they can also happen to people with more severe health issues earlier in life.

How common is a hemorrhagic stroke?

Strokes are very common. Worldwide, strokes rank second among the top causes of death. In the United States, they rank fifth. Hemorrhagic strokes make up about 10% to 15% of all strokes.

How does this condition affect my body?

A hemorrhagic stroke causes severe bleeding in or around your brain. Because this is happening inside of your skull, there’s only so much space for the bleeding to go. That puts too much pressure on the surrounding brain tissue, damaging it. If the pressure is too high or stays high for too long, that pressure destroys those brain cells, causing permanent damage.

Hemorrhagic strokes also disrupt blood flow in your brain. The effect is similar to poking a hole halfway down the side of a plastic straw. The straw still works, but it's harder to use because the hole means liquid can escape. When that happens to a blood vessel in your brain, blood can't flow as easily through the damaged vessel, reducing available blood flow to nearby brain areas.

What are the different types of hemorrhagic stroke?

Hemorrhagic stroke can happen in one of two ways:

• Bleeding inside the brain (intracerebral). This causes bleeding inside your brain, putting pressure on the surrounding brain tissue from the inside.
• Bleeding into the subarachnoid space (between your brain and its outer covering). Surrounding your brain is the arachnoid membrane, a thin layer of tissue that gets its name from the spiderweb-like pattern on its surface. The space between that membrane and your brain is the subarachnoid space ("sub" means "under"). If any blood vessels that pass through the arachnoid membrane break, bleeding from them can fill up the subarachnoid space. That causes pressure inside your skull from outside the brain itself.

What are the symptoms of a hemorrhagic stroke?

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

• Headaches (experts often call these “thunderclap” headaches because they’re sudden and severe, like an unexpected clap of thunder).
• Light sensitivity, where bright lights cause severe headache-like pain (photophobia).
• Dizziness or vertigo.
• Nausea and vomiting.
• Seizures.
• Passing out or fainting.
• Coma.
• Aphasia (difficulty with or loss of speaking ability) or slurred or garbled speaking (dysarthria).
• One-sided weakness, paralysis or loss of sense of touch.
• One-sided loss of all two-sided senses (vision, hearing and touch).
• Neck stiffness.

What causes hemorrhagic strokes?

The most common cause of a hemorrhagic stroke is high blood pressure (hypertension). This is especially true when a person’s blood pressure is very high, stays high for a long time, or both. Other conditions or causes of hemorrhagic strokes include:

• Brain aneurysms (abnormal bulging of a blood vessel wall in places where it’s weaker than normal).
• Brain tumors (including primary brain tumors and metastatic cancer).
• Other conditions that involve weakened blood vessels in your brain, such as moyamoya disease or cerebral amyloid angiopathy.
• Blood-thinning medications (these can cause bleeding in your brain or make it worse).
• Head injuries.
• Ischemic stroke that had secondary bleeding.

Related conditions

Other conditions and circumstances can contribute to high blood pressure or your general risk of having a stroke, including:

• Alcohol use disorder.
• High blood pressure (this can contribute to blood vessel damage that makes an ischemic stroke more likely to happen).
• High cholesterol (hyperlipidemia).
• Migraine headaches (they can have symptoms similar to a stroke, and people who have migraines — especially migraines with auras — also have a higher risk of hemorrhagic stroke).
• Recreational drug use or misuse of prescription drugs.
• Smoking and other forms of tobacco use (including vaping and smokeless tobacco).
• Type 2 diabetes.

Are hemorrhagic strokes contagious?

Hemorrhagic strokes aren’t contagious, and you can’t pass them from person to person.

How are hemorrhagic strokes diagnosed?

To diagnose a hemorrhagic stroke, a healthcare provider will use a neurological examination, diagnostic imaging and other tests. Because many people who have a hemorrhagic stroke are unconscious, they might not be able to answer questions or follow a provider’s instructions, which is what usually happens during a neurological exam. Because of this, providers will often test certain reflexes and look for changes in processes you can’t deliberately control, such as how your pupils react to light. These can give providers key clues to diagnose a hemorrhagic stroke even if you’re not conscious.

What tests will be done to diagnose a hemorrhagic stroke?

The most common tests that happen when a healthcare provider suspects a hemorrhagic stroke include:

• Computerized tomography (CT) scan.
• Lab blood tests (looking for signs of infections or heart damage, checking clotting ability and blood sugar levels, testing how well kidneys and liver function, etc.).
• Electrocardiogram (abbreviated ECG or EKG) to make sure a heart issue isn’t the source of the problem.
• Magnetic resonance imaging (MRI) scans.

How are hemorrhagic strokes treated?

Hemorrhagic strokes are often difficult to treat because they’re difficult to reach directly. That means it’s often not possible to stop bleeding directly. Instead, the top priority is usually to reduce the amount of bleeding or stop it entirely by boosting your body’s clotting processes and lowering blood pressure. In some cases, surgery may also be necessary. Sometimes, there can be swelling around the bleeding or elsewhere in your brain, causing increased pressure inside of your head, and medications may be needed to reduce this swelling. The treatments depend on where the stroke is in your brain, how severe it is and many other factors.

Is there anything I shouldn’t eat or drink with this condition?

If you have a hemorrhagic stroke (or any kind of stroke, for that matter), your healthcare provider may recommend changing your diet to lower your blood pressure. Examples of this include:

• Beverages that contain caffeine, such as coffee, tea, soft drinks, etc.
• Foods containing a lot of salt or sodium, which can increase blood pressure.
• Foods that are high in saturated fats, such as fried foods, etc.
• Alcohol or recreational stimulant drugs (cocaine, amphetamines/methamphetamine, etc.).

What medications or treatments are used?

There are many medications and treatments that can help in treating a hemorrhagic stroke. Those drugs and treatments often do so in one of two ways: regulating your blood pressure or helping your blood to clot more effectively. In some cases, a person might need surgery when bleeding is severe or has certain effects.

Blood pressure management

Because high blood pressure is the most common cause of hemorrhagic strokes, a top priority for treating these strokes is lowering your blood pressure and keeping it at a safe level. Doing this can reduce the amount of bleeding in your brain. It also makes it easier for blood to clot and seal the damaged blood vessel.

Clotting support

Under normal circumstances, bleeding anywhere in your body triggers a process known as hemostasis (“hemo” means “blood” and “stasis” means “standing still”). This process is how your body forms a clot to seal an injury and repair the damage.

For many people who have a hemorrhagic stroke, sometimes, their body’s ability to form a clot doesn’t work as it should. For those situations, the priority is to support the body’s hemostasis processes and make them more effective. Doing that usually involves infusion of medications or blood factors that make it easier for clotting to happen. Examples include vitamin K therapy, prothrombin or clotting factor infusions, and more.

Surgery

One of the most dangerous complications of a hemorrhagic stroke is when accumulated blood puts too much pressure on brain tissue around the bleeding blood vessel. When this happens, emergency surgery is sometimes necessary to remove the accumulated blood and relieve the pressure buildup on your brain.

Stroke rehabilitation

It’s common for people to have some lingering effects from a stroke in the days and months that follow. For many, the effects of a stroke will get slightly worse in the first few days after the stroke, and then they’ll improve.

Because it’s common for people to have lingering problems from a stroke, different types of therapy and rehabilitation are especially helpful for people recovering from a stroke. In some cases, therapy simply helps you return to how you were before your stroke. In other cases, this kind of therapy can help you relearn how to do certain things.

Your brain has a remarkable ability called neuroplasticity (pronounced “new-row-plass-tiss-it-ee”). That means your brain can adapt and change when it needs to. In some cases, your brain will “re-map” an ability, transferring control of that ability to an undamaged part of your brain. Many stroke therapy methods take advantage of that ability and speed up the process.

Stroke rehabilitation can take many forms, including:

• Speech therapy. This type of therapy focuses on the parts of your brain that manage your ability to speak and understand others when they’re talking. It also can help if you have any kind of weakness or loss of ability to control muscles in your mouth and throat. Speech therapy can not only help you talk, but can also help with breathing, swallowing, and eating or drinking.
• Physical therapy. This therapy approach focuses on improving muscle strength and control, especially with muscles in your arms, hands, legs and feet. This type of therapy can help you regain abilities like walking, dressing yourself or eating. It can also help you adapt if you have a permanent or long-term loss of an ability.
• Cognitive therapy. This kind of therapy helps strengthen your mental abilities. The main focus of this kind of therapy is improving your thinking, concentration and memory abilities.

Other treatments are possible, depending on your case and circumstances. Your healthcare provider is the best person to tell you what kind of treatments can benefit you.

Complications/side effects of the treatment

The side effects of stroke treatments can vary depending on why a stroke happened, its location in your brain, the treatments used, your medical history and more. Your healthcare provider can tell you more about the side effects that you can or should expect, and what you can do to manage or even prevent them.

How can I take care of myself or manage the symptoms?

A stroke is a life-threatening emergency condition, so you shouldn’t try to self-diagnose it. If you have — or someone with you has — stroke symptoms, you should call 911 (or your local emergency services number) right away. Delaying diagnosis and treatment of a stroke increases the danger of death or permanent brain damage.

How soon after treatment will I feel better?

Many factors can contribute to how long it takes for you to feel better after treatment for a stroke, and to recover from this condition. Your healthcare provider is the best person to tell you what to expect, and what you can do to help with your recovery.

How can I reduce my risk of having a hemorrhagic stroke or prevent them entirely?

The most important thing you can do to prevent a hemorrhagic stroke is to maintain a healthy blood pressure level. If you have high blood pressure, it’s vital to manage that condition. Your healthcare provider can help you with this, offering recommendations for what you can change in your lifestyle and treatment options.

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

• Manage your health conditions. High blood pressure is the main cause of hemorrhagic stroke, but other conditions like Type 2 diabetes and high cholesterol can contribute.
• Eat a balanced diet and maintain a healthy weight. Many conditions related to your circulatory and heart health can lead to stroke. Your weight and diet play a major role in circulatory and heart health, so managing these can help prevent or delay a stroke.
• See your primary care provider for a checkup or wellness visit annually. Problems that could cause a stroke are often detectable long before you have any symptoms you can feel. A yearly checkup with your primary care provider is key to early detection of those problems.
• Avoid risky lifestyle choices or make changes to your behaviors. Many lifestyle choices or behaviors can increase your risk of a hemorrhagic stroke. Examples include smoking and tobacco use (including vaping), prescription drug misuse or recreational drug use, alcohol misuse and more. Stopping these — or not starting them at all — can help you avoid having a stroke or reduce the severity if you have one.

What can I expect if I have a hemorrhagic stroke?

A hemorrhagic stroke usually happens very suddenly, causing severe symptoms. These symptoms usually get worse quickly, which makes fast medical attention critical. The location of the stroke, the severity of the bleeding and how fast you get care can make a huge difference in a person’s chances for survival and recovery.

Strokes can happen in similar ways, but inevitably, there are differences from person to person. Because of this, you should talk to your healthcare provider about what you can expect in your specific case. Your provider can give you information and guidance based on the specifics of your case and circumstances.

How long does a hemorrhagic stroke last, and when I can I return to school, work or my usual routine?

Hemorrhagic strokes last as long as the bleeding is happening or as long as there’s pressure on your brain from that bleeding. That means the stroke will last until you receive treatment. Without treatment, hemorrhagic strokes are virtually always deadly.

Even with treatment, the effects of a hemorrhagic stroke may linger. Some effects can be short-term, lasting days or weeks. Others may last longer, lasting for months or even permanently. Your healthcare provider is the best person to tell you what to expect in your case.

What’s the outlook for this condition?

The outlook for hemorrhagic stroke is less favorable than other kinds of stroke. That’s because it’s difficult to stop the bleeding from these strokes. It also takes a relatively small amount of blood to cause severe symptoms. Having more than 1 fluid ounce (30 mL) of accumulated blood is a key factor that decreases the risk of a good outcome. In the most severe cases, people with hemorrhagic strokes can have severe brain damage that causes a permanent coma or vegetative state, or even locked-in syndrome.

With fast medical care, some people can have a good outcome and recover from a hemorrhagic stroke. However, this varies from case to case. Your healthcare provider is the best person to tell you what you can expect and the likely outcome for your case (or the case of a loved one).

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

If you have a hemorrhagic stroke, your healthcare provider will talk with you about treatment recommendations, your recovery timeline, how you can care for yourself and more. Some of the most important things you can do as you recover include:

• Take your medications as prescribed. Managing chronic health conditions, especially your blood pressure, is crucial after a hemorrhagic stroke.
• See your provider and don’t miss appointments. Follow-up care, therapy, rehabilitation and other kinds of appointments can all help you recover as quickly and completely as possible.
• Don’t forget about your mental health. People who have strokes commonly experience depression and anxiety afterward, which can make recovery more difficult. Seeing a mental health provider about these issues is one way you can help yourself as you recover.
• Modify your lifestyle as recommended if you can. Your healthcare provider may recommend that you alter parts of how you live your life, like changing your diet, being more active, quitting smoking, etc. Following their guidance can help you recover and avoid further problems in the future.

When should I see my healthcare provider?

It’s important to see your healthcare provider as recommended for follow-up care. Your provider will schedule visits, and you should also call or see them if you notice new symptoms or issues that might have a connection to your stroke. You should also talk to them if you notice any changes that affect how you live your life or go about your regular routine, even if those issues and changes don.t seem to connect to your stroke.

When should I go to the ER?

You should call 911 (or your local emergency services number) and go to the nearest ER if you experience any symptoms of another hemorrhagic stroke (see the FAST criteria at the top of this article to know the symptoms you should watch for). Other major symptoms to watch for include sudden severe headaches (especially “thunderclap” headaches) or symptoms you had from an earlier stroke.

You should also go to the hospital if you experience any of the symptoms of dangerous complications that are common after a stroke. The most common complicating conditions include:

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

What’s the difference between a hemorrhagic stroke and a brain bleed?

A hemorrhagic stroke is a type of brain bleed that happens because of bleeding from a major blood vessel in your brain. These conditions share many common features, but they aren’t the same thing. An example of another type of brain bleed that isn’t a hemorrhagic stroke is an intraventricular bleed. These happen when there’s bleeding in the ventricles of your brain (intraventricular means “inside the ventricles,” which are small open spaces between different sections of your brain that everyone has naturally).

What’s the difference between an aneurysm and a hemorrhagic stroke?

A hemorrhagic stroke is when a blood vessel in your brain breaks open or ruptures, causing dangerous bleeding. An aneurysm is when a blood vessel in your brain bulges or swells outward in a way that it shouldn’t. Brain aneurysms can lead to hemorrhagic strokes if they leak or rupture, but they aren’t the same thing.

What is the life expectancy after a hemorrhagic stroke?

The life expectancy after a hemorrhagic stroke depends on many factors, and it’s never the same from person to person. Your healthcare provider is the best person to tell you about the life expectancy for your case or the case of a loved one.

Can you survive and recover from a hemorrhagic stroke?

Yes, surviving and recovering from a hemorrhagic stroke is possible. However, surviving and recovering depend on many factors. The best thing you can do to increase the odds of survival and recovery is to get medical care as soon as possible once you notice the symptoms of a hemorrhagic stroke.

A note from Cleveland Clinic

A hemorrhagic stroke is a severe, life-threatening medical condition that often happens quickly and without much — or any — warning. If you have the symptoms of a hemorrhagic stroke, every minute counts and it’s critical that you get medical care immediately. While this type of stroke tends to cause more severe symptoms and is often difficult to treat, fast medical care gives you a better chance of survival and recovery.