Hemorrhagic Stroke: How to Spot and Prevent It
Stroke caused by bleeding in the brain
Medically reviewed by Smita Patel, DOMedically reviewed by Smita Patel, DO
A hemorrhagic stroke causes brain damage due to bleeding. This type of stroke is caused by a blood vessel tear or leak. Symptoms include severe headaches, loss of consciousness, seizures, and weakness on one side of the body. A hemorrhagic stroke can cause severe complications due to pressure and swelling in the brain.
Risk factors that can increase the likelihood of a hemorrhagic stroke include blood vessel malformations, severe untreated hypertension, head trauma, and cerebrovascular disease. About 13% of all strokes are hemorrhagic strokes. They can be life-threatening.
This article describes hemorrhagic strokes and what to expect if you or a loved one has been diagnosed with this type of stroke.
eclipse_images / Getty Images
What Causes a Hemorrhagic Stroke?
A hemorrhagic stroke can occur when a blood vessel in the brain starts to bleed or bursts. A brain aneurysm is a blood vessel outpouching that can make blood vessels susceptible to bleeding.
Sometimes the area around an ischemic stroke (a stroke caused by insufficient blood flow) can bleed. This is called hemorrhagic conversion. Additionally, head trauma can cause bleeding in the brain.
Bleeding in the brain causes brain damage and a decrease in blood supply to the areas around the bleeding. Hemorrhagic strokes also cause edema (swelling) and subsequent pressure in the brain that can worsen the damage.
What Are the Risk Factors for a Hemorrhagic Stroke?
Risk factors for ischemic stroke can increase the likelihood of a hemorrhagic stroke.
There are also additional risk factors that increase the likelihood of experiencing a hemorrhagic stroke:
Having a brain aneurysm
Kidney disease
Dementia
Family history of hemorrhagic stroke
Cancer in the brain
Amyloid angiopathy, a type of blood vessel disease
Additionally, Black and Hispanic adults are at a higher risk of stroke than White counterparts. This is believed to be due to a combination of hereditary risk factors and differences in access to care.
Risk Factors for Strokes
Having a history of any type of stroke or having stroke risk factors makes it more likely to experience a hemorrhagic stroke.
Stroke risk factors include:
Smoking
Untreated hypertension
Uncontrolled diabetes
Heart disease, including atrial fibrillation
High low-density lipoprotein (LDL) cholesterol, low high-density lipoprotein (HDL) cholesterol, and high triglyceride levels
Heavy drinking
Being overweight
A sedentary lifestyle
Vascular inflammation due to underlying disorders such as lupus, rheumatoid arthritis, untreated human immunodeficiency virus (HIV), or cancer
Chronic stress
Atherosclerotic vascular disease (a buildup of fats, cholesterol, and other substances on artery walls) is a major risk factor for stroke and heart disease. Many of the conditions that lead to vascular disease are also independent risk factors for stroke.
Metabolic syndrome, which includes being overweight, hypertension, high cholesterol levels, and prediabetes, is a stroke risk factor.
Types of Hemorrhagic Stroke
A hemorrhagic stroke can occur in the brain tissue (intracerebral hemorrhage) or in the space around the brain (subarachnoid hemorrhage).
| Subarachnoid Hemorrhage | Intracerebral Hemorrhage |
Causes | Ruptured brain aneurysm Trauma | Ischemic stroke |
Risk Factors | Untreated hypertension | Large stroke |
Symptoms | Sudden, severe headache | Worsening ischemic stroke symptoms |
Treatment | Brain aneurysm repair |
Common Symptoms of a Hemorrhagic Stroke
Stroke symptoms can come on suddenly, especially with a hemorrhagic stroke. Getting prompt medical attention is critical if you notice any of these symptoms in yourself or someone else.
A common way to recognize stroke symptoms is to remember the acronym FAST:
Face: Uneven face, droopy eyelid, or uneven smile
Arm: One side of the body is weaker or feels different than the other
Speech: Difficulty speaking, communicating, or understanding what other people are saying
Time: Call 911 for help immediately
Additionally, if you have a severe headache, changes in consciousness, or seizures, call 911.
How a Hemorrhagic Stroke Is Diagnosed
A hemorrhagic stroke is diagnosed by the same methods as an ischemic stroke. Healthcare providers assess symptoms, do a physical examination, and order diagnostic testing. A hemorrhagic stroke can often be diagnosed quickly with a computerized tomography (CT) scan of the brain.
After an initial diagnosis, other testing may include:
Blood tests: These can help in identifying conditions that may lead to stroke or to susceptibility to bleeding.
Magnetic residence imaging (MRI) of the brain: This test can identify brain damage, such as early ischemic changes.
Brain angiography: This test can visualize the blood vessels in the brain to identify abnormalities that may require surgical intervention.
Often, brain imaging is repeated days after a hemorrhagic stroke to assess whether bleeding has slowed and edema is subsiding.
Emergency Treatment for a Hemorrhagic Stroke
A hemorrhagic stroke often requires prompt medical intervention. There are many different treatments, and the decision regarding which treatments are best for you or your loved one depends on many factors.
Treatments include:
Blood pressure management
Blood sugar stabilization
Medication to reduce brain edema
Fluid management
Sometimes, surgery is necessary to help prevent the damage of hemorrhagic stroke.
Surgical Treatment
Surgical treatment after a hemorrhagic stroke may include a temporary removal of a portion of the skull (hemicraniectomy) in order to reduce the pressure from the bleeding and swelling. Sometimes, removal of blood is possible as well.
If a brain aneurysm is found during diagnostic testing, it may need to be repaired to prevent recurrent bleeding.
Learn More: A Complete Guide to Stroke Surgeries
Recovery From a Hemorrhagic Stroke
Recovering from a hemorrhagic stroke can take months or longer. Recovery can include rehabilitation, physical therapy, and occupational therapy. These therapies will be tailored to help you or your loved one regain skills that were lost due to the stroke.
Additionally, lifestyle changes may be necessary to maintain optimal health and prevent a future stroke. These changes may include smoking cessation, dietary adjustments, staying active to lose weight, and stress management.
The Rehabilitation Process
Different aspects of rehabilitation after a stroke can include:
Speech therapy
Swallow therapy
Physical therapy to regain strength and coordination
Cognitive therapy to help with communication and thinking skills
Occupational therapy to better adapt to physical limitations caused by the stroke
You may need a long-term plan that involves working with multiple specialists as you recover from a hemorrhagic stroke. Rehabilitation may take place in a variety of settings, including inpatient facilities, skilled nursing facilities, outpatient clinics, and at home.
Learn More: Stroke Rehabilitation: What to Expect
Complications of a Hemorrhagic Stroke
Complications may occur after a hemorrhagic stroke, although not everybody will experience every complication.
Some potential complications may include:
Epilepsy (seizure disorder)
Paralysis
Impaired speech
Vision loss
Cognitive (thinking and reasoning) impairment
Difficulty walking
Persistent, recurrent headaches
Difficulty chewing or swallowing
The level of impairment you may experience will likely be related to the location of the hemorrhagic stroke in your brain. For example, people who have bleeding in the frontal lobe may have difficulty with cognitive skills, while people who experience bleeding in the parietal lobe can have weakness on one side of the body or impaired speech.
Related: Complications of Subarachnoid Hemorrhage
How to Prevent a Hemorrhagic Stroke
Strategies for reducing the risk of hemorrhagic stroke include lifestyle modifications and medical interventions.
Prevention of a hemorrhagic stroke is based on strategies similar to ischemic stroke prevention approaches. If you have certain risk factors, you may have additional preventative strategies that you need to keep in mind.
Prevention includes:
Controlling diabetes
Maintaining a healthy weight
Keeping your cholesterol and triglycerides at a healthy level
Staying physically active
Avoiding smoking or quitting if you smoke
Getting treatment for heart disease if you have heart disease
Consuming alcohol in moderation or not consuming any at all
Not using recreational drugs
If you have a brain aneurysm, get treatment or medical observation
If you have a history of brain aneurysm, get screening
What’s the Outlook for Someone After a Hemorrhagic Stroke?
In general, a hemorrhagic stroke is considered dangerous, and for some people it is life-threatening. The damage after hemorrhagic stroke can cause permanent weakness—which may necessitate using a cane, a walker, or a wheelchair.
Additionally, some people need to remain on anti-seizure medication for the long term, because a hemorrhagic stroke may cause epilepsy.
Recovery after a hemorrhagic stroke is variable—some people may be able to maintain independence, drive, and return to work, while others may need assistance with activities of daily living. Your recovery can be anywhere in between these extremes.
How much recovery you should expect is hard to predict, but the larger the stroke is, the more severe the anticipated disability. Additionally, having had previous strokes or other health problems can make the overall outcome worse.
Hemorrhagic Stroke in Children
A child who has a severe traumatic head injury during birth or due to an accident could experience a hemorrhagic stroke. The outlook depends on the severity of the bleeding, the extent of damage, the location of the bleeding, and how promptly treatment begins.
If your child has experienced a hemorrhagic stroke, they will likely need close medical observation and care. With guidance and rehabilitation, you should be able to get an idea from your child’s doctors about recovery and long-term expectations.
Summary
Hemorrhagic stroke, which is less common than ischemic stroke, is a type of stroke that is caused by bleeding in the brain. A hemorrhagic stroke can cause weakness in one side of the body, speech impairment, vision changes, and a severe and sudden headache.
Complications of a hemorrhagic stroke can include vision loss, paralysis, loss of speech abilities, and seizures. Hemorrhagic strokes can be life-threatening.
Treatment can involve fluid management, blood pressure management, and seizure control. It may also require a surgical procedure to remove blood and reduce damage caused by brain swelling.
Recovery after a hemorrhagic stroke involves physical therapy and rehabilitation, as well as treatment to prevent another stroke.
Read the original article on Verywell Health.
