A hemorrhagic stroke is a medical emergency caused by a ruptured blood vessel in the brain. It cuts off oxygen and nutrients to parts of the brain, killing cells.
The most common cause is high blood pressure, an aneurysm or a bleeding disorder. It may also be related to age or certain health conditions. Early symptoms include a severe headache (often described as thunderclap headache) and sensitivity to light.
Symptoms
A hemorrhagic stroke occurs when a blood vessel in the brain bursts. It’s sometimes called a bleed or an aneurysm. The symptoms of a hemorrhagic stroke depend on what area of the brain is affected. They can be different for everyone, and they can range from mild to severe.
Hemorrhagic stroke can be caused by conditions that damage blood vessels in the brain, like Moyamoya disease or cerebral amyloid angiopathy, as well as high blood pressure, aging, smoking, diabetes and other health problems that make it harder for your blood to clot. It’s also more common in people who have had a previous stroke or TIA.
Symptoms of a hemorrhagic ischemic stroke can include a sudden loss of muscle movement (paralysis), problems with balance or coordination, and slurred or garbled speech. You may have a headache that feels like a clap of thunder or a light sensitivity known as photophobia.
Your doctor will do a physical exam and ask about your past health. He or she will also look for any weakness on one side of your body and check your ability to lift your arms over your head. A CT scan may be done to see the cause of your hemorrhage. If you have taken any blood thinners, your doctor will probably need to stop them and give you medication to reverse their effect.
A MRI may be used to show areas of the brain with bleeding. This is usually done if your symptoms are more serious or if you’ve had a bleed that’s causing a lot of pressure inside your skull.
If you have a hemorrhagic stroke, your doctor will treat the symptoms right away. They may prescribe drugs to treat blood pressure, prevent more bleeding and help your blood clot. They will probably also put you in a hospital for close monitoring and treatment. Surgical treatment is used for some patients, especially those with large lobar hemorrhages or those who have brainstem compression and hydrocephalus. This is usually done in the intensive care unit. Other surgery can be done to remove a clot from the brain or reduce pressure in the skull.
Diagnosis
Bleeding in the brain (intracerebral hemorrhage) disrupts blood flow, making it harder for nearby brain tissue to get enough blood. It’s also dangerous because accumulated blood puts pressure on the brain and can damage it, especially if the brain is already damaged by other causes.
The first sign of a hemorrhagic stroke is usually headache, often severe. Other symptoms include slurred speech, difficulty walking, and weakness on one side of the body.
A CT scan is the best way to see if you or someone else has this kind of stroke. It can show where the bleed is located and how big it is. It can also help rule out other causes, such as a tumor or an infection.
If the person has a hemorrhagic stroke, treatment is vital. The longer the stroke goes on, the more damage it can cause. And a hemorrhagic stroke can be more severe than an ischemic stroke. So getting medical care quickly is key to survival and recovery.
In a hemorrhagic stroke, doctors need to control bleeding and lower pressure in the brain right away. That can involve repairing damaged blood vessels or sealing an aneurysm. It may also mean surgery to open the skull and relieve pressure built up by accumulated blood. And it may require infusion of medications or blood factors that support the body’s natural clotting processes and make them more effective.
Medications can also be used to reduce pain and prevent seizures. They can also slow the onset of dementia and other conditions that can affect people who’ve had a stroke. People who survive a hemorrhagic stroke sometimes need long-term rehabilitation to help them adjust to their new lives. It can include physical therapy and occupational therapy, as well as emotional and social support. People who have had a hemorrhagic stroke are at high risk of another stroke, so they should follow up with their health care providers as scheduled. And they should tell their provider about any new issues or changes, even if they don’t seem related to the stroke.
Treatment
Hemorrhagic strokes can be more difficult to treat than ischemic stroke, because the blood supply to part of the brain is cut off when a blood vessel bursts. If the hemorrhagic stroke is caused by an aneurysm or defective blood vessel, surgery can help prevent additional strokes by sealing off the defect and redirecting blood flow to other vessels that supply the brain in the affected area.
If the hemorrhagic stroke happens due to bleeding on the surface of the brain, treatment may involve medications to control your blood pressure and to help your body form clots. It is important to let your healthcare provider know if you have high blood pressure or take medications for it, because these may increase your risk of having a hemorrhagic stroke.
In some cases, the only FDA-approved medication for treating a stroke is tissue plasminogen activator (tPA). However, this drug must be given within three hours of the onset of symptoms to have a chance to work, and only 3-5% of people who have a stroke reach the hospital in time to receive it.
A hemorrhagic stroke that occurs due to subarachnoid hemorrhage is often fatal. Depending on where the bleeding is occurring, other complications can include seizures, loss of consciousness or a sudden severe headache called thunderclap headache.
After a hemorrhagic stroke, you may need to undergo physical or occupational therapy to improve your strength and range of motion, and learn how to manage activities that were once easy for you. It is also important to talk with your healthcare provider about any problems or changes you have noticed since the stroke, even if they don’t seem related to the hemorrhage.
Hemorrhagic strokes are more likely to cause long-term disabilities than other kinds of stroke. But, if you are treated early and get the right care, you can still make a good recovery. To reduce your risk of having another hemorrhagic stroke, follow your doctor’s recommendations for healthy eating and lifestyle, and use blood-thinning medications only as instructed by your doctor. Also, do not smoke or drink alcohol.
Prevention
People who follow a healthy diet, exercise regularly and maintain a normal weight can reduce their risk of stroke. Controlling high blood pressure, cholesterol and other medical conditions also helps prevent stroke. If you have a history of heart disease, diabetes or other risk factors, see your primary care provider for regular checkups and wellness visits.
If you suspect someone is having a stroke, look for one side of their face to see if it droops. Also, ask them to raise their arms. If one arm stays up and the other drops, this is a sign of muscle weakness or paralysis caused by a stroke. Other symptoms include trouble walking, slurred speech or trouble understanding what others are saying.
Anybody can have a stroke, but the risk increases as we get older. Two-thirds of strokes happen in people over 65. There are also certain medical conditions that increase your risk, such as high blood pressure (hypertension), high cholesterol, diabetes, heart disease and atrial fibrillation.
Hemorrhagic strokes happen when a blood vessel in the brain ruptures and bleeds. This disrupts the flow of blood in the brain and cuts off oxygen to brain cells, causing them to die. This type of stroke is less common than ischemic stroke, which happens when a clot blocks an artery in the brain.
Treatment for hemorrhagic stroke starts with finding and controlling the bleeding in the brain. Emergency surgery may be needed to remove accumulated blood and relieve pressure on the brain. Medications to support the body’s natural clotting processes or to make it easier for clots to form can help, too. These include infusions of vitamin K, prothrombin or clotting factors.
The outlook for recovery depends on the severity of your symptoms and how quickly you seek medical attention. The earlier you receive treatment, the better your chances of preventing long-term disability from a stroke. For this reason, it’s important to know the symptoms of a stroke and call emergency services right away. Keeping a calendar and paying close attention to the time when symptoms started can help you remember what happened and when, so you can tell your doctor.
