Hemorrhagic Stroke

What Causes a Hemorrhagic Stroke?

A hemorrhagic stroke happens when a weakened blood vessel in the brain ruptures, causing bleeding (hemorrhage) into or around the brain. This bleeding increases pressure on the brain and damages brain cells. Hemorrhagic strokes are less common than ischemic strokes but are more deadly and more likely to cause serious disability.

There are two main types:

• Intracerebral hemorrhage: Bleeding directly into the brain tissue.
• Subarachnoid hemorrhage: Bleeding in the space between the brain and its outer covering, often due to a ruptured aneurysm.

Who Is Affected?

Hemorrhagic strokes can occur at any age but are more common in adults over 45, especially those with high blood pressure. Certain populations, such as African Americans and Asian Americans, are at higher risk due to increased prevalence of hypertension and vascular disease.

What Causes a Hemorrhagic Stroke?

The most common cause is chronic high blood pressure, which weakens blood vessel walls. Other causes include:

• Aneurysms: weakened vessel walls that bulge and burst
• Arteriovenous malformations (AVMs): Congenital tangles of abnormal blood vessels
• Head trauma
• Blood-thinning medications
• Bleeding disorders
• Drug use (especially cocaine or amphetamines)

Risk Factors:

Not Controllable

• Age (risk increases with age)
• Family history of aneurysms or stroke
• Congenital blood vessel abnormalities (like AVMs)

Controllable

• High blood pressure 
• Smoking
• Heavy alcohol use
• Recreational drug use
• Use of anticoagulants without proper monitoring
  
  

Who Is Most at Risk?

Individuals with poorly controlled high blood pressure, those taking blood thinners, and people with brain aneurysms or AVMs face the highest risk. Head trauma - especially from falls or accidents - also contributes, particularly among older adults.

How to Reduce Your Risk

• Keep blood pressure within normal range
• Quit smoking
• Limit alcohol and avoid illicit drugs
• Manage chronic conditions like diabetes and high cholesterol
• Follow up on abnormal imaging findings like aneurysms
• Take prescribed medications exactly as directed

Common Symptoms
Symptoms of a hemorrhagic stroke often appear suddenly and without warning, and may include:

Common Stroke Symptoms (BE FAST)
Recognize stroke symptoms using the BE FAST acronym:

Other symptoms may include:

• Sudden severe headache ("worst headache of your life")
• Nausea or vomiting
• Confusion
• Seizures or loss of consciousness

How Is It Diagnosed?

Prompt diagnosis is critical to stop the bleeding and reduce brain damage. Providers will:

• Assess symptoms and conduct a neurological exam
• Evaluate medical history and current medications
  

Diagnostic Tests

• CT scan: The fastest and most common tool to detect bleeding.
• MRI: Provides detailed brain images.
  
• Cerebral angiography: Visualizes blood vessels to identify aneurysms or AVMs.
  
• Lumbar puncture: Occasionally used to detect bleeding not seen on imaging.
• Blood tests: Assess clotting function and medication levels.

How Is a Hemorrhagic Stroke Treated?

Treatment focuses on stopping the bleeding, relieving pressure, and preventing complications.

Medical Treatments

• Blood pressure control with IV medications
• Reversal of blood thinners if applicable
• Medications to prevent seizures or reduce swelling in the brain
  
  

Surgical & Interventional Treatments

• Craniotomy: Surgical removal of the hematoma to relieve pressure
  
• Aneurysm clipping: A metal clip seals off the aneurysm
  
• Endovascular coiling: A catheter delivers coils to seal off an aneurysm 
• AVM removal or radiosurgery

Lifestyle Changes Post-Stroke

• Manage blood pressure and other risk factors
• Follow a healthy diet and exercise plan
• Avoid alcohol and drugs

Rehabilitation

• Physical therapy for movement and balance
• Occupational therapy for daily tasks
• Speech therapy for communication issues

When to Seek Emergency Care

Warning Signs That Require Immediate Help

Any signs or symptoms of a stroke are a medical emergency, and you should call 911 immediately.

• BALANCE: If there is a sudden loss of balance or coordination
• EYES: If there is a sudden loss of vision in one or both eyes or if vision becomes blurry
• FACIAL DROOPING: If there is a sudden weakness in the face – especially on only one side
• ARM WEAKNESS: If there is sudden weakness in an arm or leg
• SPEECH: If there is a sudden difficulty speaking or slurring of speech
• TIME TO CALL 911
  
  

Other symptoms may include:

• Sudden severe headache ("worst headache of your life")
• Nausea or vomiting
• Confusion
• Seizures or loss of consciousness
  
  

Don’t Wait

Hemorrhagic strokes progress quickly and can be fatal without emergency care. Fast intervention improves survival and recovery chances.

What Should You Do Next?

• Know the signs of a stroke and teach them to your family. Check out our Stroke Smart Community page you want materials and resources to help teach others to recognize the signs and symptoms of stroke.
• Manage your risk factors, especially blood pressure; Schedule regular checkups and follow your treatment plan.
• If you have a family history of aneurysms or AVMs, ask your doctor about screening.
• Talk to your doctor if you have concerns about stroke prevention or symptoms.