What is Hemorrhagic Stroke

Hemorrhagic stroke is the sudden death of brain tissue that occurs when a blood vessel in the brain leaks or bursts (ruptures). When this happens, certain areas of the brain do not get enough oxygen, and blood builds up and presses on certain areas of the brain (hemorrhage).

Lack of oxygen and pressure from hemorrhaging can lead to brain damage.

There are two major types of hemorrhagic stroke, depending on where bleeding occurs. If bleeding occurs within the brain tissue, the condition is called an intracerebral hemorrhage. If bleeding occurs in the area between the brain and the membrane that covers the brain (subarachnoid space), the condition is called a subarachnoid hemorrhage. Hemorrhagic stroke is a medical emergency. It can cause temporary or permanent brain damage and loss of brain function.

What are the causes?

This condition is caused by a blood vessel leaking or rupturing, which may be the result of:

• Part of a weakened blood vessel wall bulging or ballooning out (cerebral aneurysm).
• A hardened, thin blood vessel cracking open and allowing blood to leak out. Blood vessels may become hardened and thin due to plaque buildup.
• Tangled blood vessels in the brain (brain arteriovenous malformation).
• Protein buildup on artery walls in the brain (amyloid angiopathy).
• Inflamed blood vessels (vasculitis).
• A tumor in the brain.
• High blood pressure (hypertension).

What increases the risk?

The following factors may make you more likely to develop this condition:

• Hypertension.
• Having abnormal blood vessels present since birth (congenital abnormality).
• Bleeding disorders, such as hemophilia, sickle cell disease, or liver disease.
• The blood becoming too thin while taking blood thinners (anticoagulants).
• Aging.
• Moderate or heavy alcohol use.
• Using drugs, such as cocaine or methamphetamines.

What are the signs or symptoms?

Symptoms of this condition usually appear suddenly, and may include:

• Weakness or numbness of the face, arm, or leg, especially on one side of the body.
• Confusion.
• Difficulty speaking (aphasia) or understanding speech.
• Difficulty seeing out of one or both eyes.
• Difficulty walking or moving the arms or legs.
• Dizziness.
• Loss of balance or coordination.
• Seizures.
• A severe headache with no known cause. This headache may feel like the worst headache ever experienced.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Tests, including:
  • Blood tests.
  • CT scan.
  • MRI.
• Angiogram. In this procedure, dye is injected through a long, thin tube (catheter) into one of your arteries. Then, X-rays are taken. The X-rays will show whether there is a blockage or a problem in a blood vessel.

How is this treated?

This condition is a medical emergency that must be treated in a hospital immediately. The goals of treatment are to stop bleeding, reduce pressure on the brain, and relieve symptoms. Treatment may include:

• Medicines that:
  • Lower blood pressure (antihypertensives).
  • Relieve pain (analgesics).
  • Relieve nausea or vomiting.
  • Stop or prevent seizures (anticonvulsants).
  • Relieve fever.
  • Prevent blood vessels in the brain from spasming in response to bleeding.
  • Control bleeding in the brain.
• Assisted breathing (ventilation). This involves using a machine to help you breathe (ventilator).
• Receiving donated blood products through an IV tube (transfusion). You will receive cells that help your blood clot.
• Placement of a tube (shunt) in the brain to relieve pressure.
• Physical, speech, or occupational therapy.
• Surgery to stop bleeding, remove a blood clot or tumor, or reduce pressure.

Treatment depends on the cause, severity, and duration of symptoms.

Medicines and changes to your diet may be used to help treat and manage risk factors for stroke, such as diabetes and high blood pressure.

Follow these instructions at home:

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Rest. Rest helps the brain to heal. Make sure you:
  • Get plenty of sleep. Avoid staying up late at night.
  • Keep a consistent sleep schedule. Try to go to sleep and wake up at about the same time every day.
  • Avoid activities that cause physical or mental stress.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or operate heavy machinery until your health care provider approves.
• Limit alcohol intake to no more than 1 drink per day for nonpregnant women and 2 drinks per day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
• Use a walker or a cane as told by your health care provider.
• Keep all follow-up visits as told by your health care provider, including visits with therapists. This is important.

How is this prevented?

Your risk of stroke can be decreased by working with your health care provider to treat high blood pressure, high cholesterol, diabetes, heart disease, and obesity. Your risk of stroke can also be decreased by quitting smoking, limiting alcohol, and staying physically active.

If you take the blood thinner warfarin, have your bloodwork monitored frequently by your health care provider.

Contact a health care provider if:

You develop any of the following symptoms:

• Headaches that keep coming back (chronic headaches).
• Nausea.
• Vision problems.
• Increased sensitivity to noise or light.
• Depression or mood swings.
• Anxiety or irritability.
• Memory problems.
• Difficulty concentrating or paying attention.
• Sleep problems.
• Feeling tired all of the time.

Recovery from hemorrhagic stroke varies widely. Talk with your health care provider about what to expect during your recovery.

Get help right away if:

• You develop symptoms of a hemorrhagic stroke.
• You have a partial or total loss of consciousness.
• You are taking blood thinners and you fall or you experience minor injury (trauma) to the head.
• You have a bleeding disorder and you fall or you experience minor trauma to the head.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services. Do not drive yourself to the hospital.