Hemorrhagic Stroke: Symptoms, Treatment, and Long-Term Outlook
A stroke occurs when the flow of blood to part of the brain is cut off or significantly reduced. Without the oxygen carried by the blood, brain cells can die very quickly, resulting in lasting damage. Strokes can be major or minor and the consequences can range from complete recovery to fatality.
Immediate medical treatment is important for the best odds of recovery. Prevention is also important. If you control your risk factors, you can greatly reduce your odds of having any type of stroke.
According to the American Stroke Association, 13 percent of strokes are hemorrhagic. These are strokes that are caused by a rupture in a weakened blood vessel in the brain. The majority of strokes are ischemic, or the result of a blood clot.
A hemorrhagic stroke occurs when a blood vessel ruptures and blood accumulates in the tissue around the rupture. This produces pressure on the brain and a loss of blood to certain areas.
Two Types of Hemorrhagic Stroke
There are two possible causes of a ruptured blood vessel in the brain. The most common cause is an aneurysm. An aneurysm occurs when a section of a blood vessel becomes enlarged from blood pressure. This ballooning leads to thinning of the vessel wall, and ultimately to a rupture.
A rarer cause of a hemorrhagic stroke is an arteriovenous malformation (AVM). This occurs when blood vessels are tangled together, resulting in blood bypassing part of the brain. AVMs are congenital. This means they are present at birth, but they are not hereditary. It is unknown exactly why they occur in some people.
Symptoms of an Intracerebral Hemorrhage
If a hemorrhagic stroke occurs inside your brain, it is called an intracerebral hemorrhage, or ICH. Symptoms of an ICH can vary from person to person, but are almost always present immediately after the stroke occurs.
Symptoms may include total or limited loss of consciousness, nausea and vomiting, a sudden and severe headache, and weakness or numb feeling in the face, leg, or arm on one side of the body. Someone experiencing a stroke due to an AVM may also have seizures.
Symptoms of a Subarachnoid Hemorrhage
Less commonly, a hemorrhage may occur in the space around your brain. This is called a subarachnoid hemorrhage, or SAH. An SAH may be preceded by headaches due to small leaks of blood.
A full SAH causes a sudden onset of symptoms. These symptoms may include a severe headache, nausea and vomiting, a stiff feeling in the neck, an inability to tolerate light, and loss of consciousness.
Emergency Treatment for a Hemorrhagic Stroke
Immediate emergency care is crucial for a hemorrhagic stroke. This treatment focuses on controlling the bleeding in your brain and reducing the pressure caused by the bleeding.
Drugs can be used to reduce blood pressure or to slow down the bleeding. If you experience a hemorrhagic stroke while on blood thinners, you are at particular risk for excessive bleeding. Drugs to counteract the effect of the blood thinners are usually given right away during emergency treatment.
Once a hemorrhagic stroke is brought under control with emergency care, further treatment measures can be taken. If the rupture is small and produces only a small amount of bleeding and pressure, bed rest may be the only form of care you need.
For more serious strokes, surgery may be needed to repair the ruptured blood vessel and stop the bleeding. If the stroke is caused by an AVM, surgery may be used to remove it. This is not always possible, however, and depends on the location of the AVM.
Recovery from a Hemorrhagic Stroke
The duration of recovery and rehabilitation depends on the severity of the stroke. It also depends on the amount of tissue damage that occurred. Different types of therapy may be involved, depending on your needs. Options include physical therapy, occupational therapy, or speech therapy. The primary goal of therapy is to restore as much function as possible.
The Outlook for Hemorrhagic Stroke Patients
Your outlook for recovery depends on the severity of the stroke, the amount of tissue damage, and how soon you were able to get treatment. The recovery period is long for many patients. It can last for months or even years. Most patients, however, are able to function well enough to live at home within weeks. The chances of surviving a hemorrhagic stroke are less than for an ischemic stroke.
Preventing a Hemorrhagic Stroke
There are certain risk factors for a hemorrhagic stroke. If you can avoid these factors, you reduce your odds of experiencing one. High blood pressure is the most likely cause of an ICH. Keeping your blood pressure under control is the best way to control your risk. Talk to your doctor about how to lower your blood pressure if it is too high.
Alcohol and drug use are also controllable risk factors. Consider drinking in moderation and avoid any type of drug abuse. Blood thinners help prevent ischemic strokes but can also increase your odds of having an ICH. If you are on blood thinners, be sure to speak to your doctor about the risks.
- Hemorrhagic Stroke Fact Sheet. (2009, June). National Stroke Association. Retrieved January 11, 2014, from http://www.stroke.org/site/DocServer/NSAFactSheet_HemorrhagicStroke_7-09.pdf?docID=3025
- Hemorrhagic Strokes (Bleeds). (2013, November 7). American Stroke Association. Retrieved February 5, 2014, from http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds_UCM_310940_Article.jsp
- Stroke. (2013, May 28). National Institutes of Health. Retrieved January 11, 2014, from http://www.nlm.nih.gov/medlineplus/ency/article/000726.htm
- What is an Arteriovenous Malformation? (2013, February 20). American Stroke Association. Retrieved January 11, 2014, from http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/What-Is-an-Arteriovenous-Malformation-AVM_UCM_310099_Article.jsp
- What You Should Know About Cerebral Aneurysms. (2013, February 20). American Stroke Association. Retrieved January 11, 2014, from http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/What-You-Should-Know-About-Cerebral-Aneurysms_UCM_310103_Article.jsp