A hemorrhagic stroke is when there’s uncontrolled bleeding inside of your brain itself or in the space between your brain and its outer covering layer. This kind of stroke is especially severe and can happen and get worse quickly. Immediate medical attention is absolutely critical to avoid permanent brain damage or death.
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:
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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.
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.
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.
Hemorrhagic stroke can happen in one of two ways:
The symptoms of a hemorrhagic stroke can include one or more of the following:
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:
Other conditions and circumstances can contribute to high blood pressure or your general risk of having a stroke, including:
Hemorrhagic strokes aren’t contagious, and you can’t pass them from person to person.
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.
The most common tests that happen when a healthcare provider suspects a hemorrhagic stroke include:
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.
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:
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.
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.
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.
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.
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:
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.
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.
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.
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.
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:
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.
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.
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).
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:
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.
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:
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).
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.
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.
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.
Last reviewed by a Cleveland Clinic medical professional on 08/07/2022.
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