Hemorrhagic Stroke: Symptoms, Treatment, and Long-Term Outlook

Hemorrhagic Stroke

What is a stroke?

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 quickly, which can cause permanent brain damage. Strokes can be major or minor and the consequences can range from complete recovery to fatality.

There are two types of strokes: ischemic and hemorrhagic. An ischemic stroke is caused by lack of blood flow to brain tissue. This can be caused when the arteries in the brain narrow because of a condition such as atherosclerosis. A blood clot can form in the narrow arteries and block blood flow. This is called a thrombosis. Another cause of ischemic strokes is an embolism. This occurs when a blood clot forms somewhere in the body and then travels to the brain and blocks blood flow. 

What is atherosclerosis? »

About 13 percent of strokes are hemorrhagic. These are strokes that are caused by a rupture in a blood vessel in the brain. The majority of strokes are ischemic.

A hemorrhagic stroke is also called an intracerebral hemorrhage, or an ICH. An ICH occurs when a blood vessel ruptures and blood accumulates in the tissue around the rupture. This puts pressure on the brain and causes a loss of blood to the surrounding areas.

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.

Symptoms of a hemorrhagic stroke


A hemorrhagic stroke that occurs inside your brain is also called an intracerebral hemorrhage. 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
  • vomiting
  • sudden and severe headache
  • weakness or numb feeling in the face, leg, or arm on one side of the body
  • seizures
  • dizziness
  • loss of balance
  • problems with speech or swallowing
  • confusion or disorientation

A stroke is a medical emergency. Call emergency medical services or have someone drive you to the hospital if you think you’re having a stroke.

Causes of a 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 chronic and dangerously high blood pressure or when a blood vessel wall is weak, which is usually congenital. This ballooning leads to thinning of the vessel wall, and ultimately to a rupture.

A rarer cause of an ICH is an arteriovenous malformation (AVM). This occurs when arteries and veins are connected abnormally without capillaries between them.  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.

What is an arteriovenous malformation? »

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.

Surgical 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, supportive care may be the only other form of care you need. This may include:

  • IV fluids
  • rest
  • management of other medical problems
  • speech, physical, or occupational therapy

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. Surgery may also be required to relieve the pressure caused by the bleeding and brain swelling.

Recovery from a hemorrhagic stroke


The duration of recovery and rehabilitation depends on the severity of the stroke and 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 people, lasting for months or even years. However, most people with small strokes and no additional complications during the hospital stay are able to function well enough to live at home within weeks.

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’s 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.

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