Overview

What Is Hemorrhagic Stroke?

A hemorrhagic stroke results when a blood vessel in your brain ruptures or breaks, spilling blood into the surrounding tissues. Less common and often more serious than ischemic strokes, hemorrhagic strokes account for roughly 13% of all strokes but are responsible for approximately 40% of all stroke deaths. Patients who recover may face long-term physical or mental disability.

Hemorrhagic strokes often occur as a result of a variety of causes, including high blood pressure, an aneurysm, drug abuse, trauma and arteriovenous malformations (AVMs), a genetic condition that causes blood vessels form incorrectly.

Types of hemorrhagic strokes

• An intracerebral hemorrhage is the most common type of hemorrhagic stroke, occurring when the bleeding takes place inside of the brain.
• A subarachnoid hemorrhage is less common, occurring when the bleeding takes place between the brain and the surrounding membranes.

If a hemorrhagic stroke is suspected, seek medical help immediately. Symptoms can include seizure, loss of vision or consciousness, difficulty speaking and loss of balance or coordination. After a physical examination, imaging tests such as CT scans or MRIs can aid in the diagnosis. Emergency treatment focuses first on stopping the bleeding and relieving pressure. Surgery may be required to prevent another hemorrhagic stroke from occurring.

Symptoms

In a hemorrhagic stroke, an aneurysm (weak bulge in the artery) or high blood pressure causes a blood vessel in the brain to burst. Leakage of blood causes brain swelling and an increase of pressure in the skull, which damages brain cells and tissue. Stroke symptoms come on suddenly.

Symptoms of stroke include:

• Weakness: You may feel a sudden weakness, tingling or a loss of feeling on one side of your face or body, including your arm or leg.
• Vision problems: You may have sudden double vision or trouble seeing in one or both eyes.
• Speech problems: You may have sudden trouble talking, slurred speech or problems understanding others.
• Headache: You may have a sudden, severe headache.
• Movement problems: You may have sudden trouble walking, dizziness, a feeling of spinning, a loss of balance, a feeling of falling or blackouts.

Think FAST

The National Stroke Association’s acronym FAST can help you quickly determine whether someone is having a stroke:

• F (Face): Ask the person to smile. Does one side of his or her face droop?
• A (Arms): Ask the person to raise both arms. Does one arm drift downward?
• S (Speech): Ask for a simple phrase (such as,“You can’t teach an old dog new tricks”) to be repeated. Is speech slurred or hard to understand?
• T (Time): If you observe any of these signs, call 911 immediately.

If you or someone else has any of these symptoms, act FAST and call 911. With stroke, time lost is brain lost.

Causes

Conditions that can cause hemorrhagic stroke include:

• High blood pressure: Uncontrolled high blood pressure can cause damage to the blood vessels and to the body over time, increasing the risk of rupture and stroke.
• Aneurysm: Bulges in arteries can swell, stretch and weaken the artery wall and burst, causing a stroke. High blood pressure can make an aneurysm more likely to rupture.
• Arteriovenous malformations (AVMs): Tangles of faulty blood vessels can rupture, causing stroke. High blood pressure may increase the likelihood of an AVM bursting.

Diagnoses

Knowing the type of stroke will determine the best course of treatment and therapy to help you recover. Experienced neurologists at Northwestern Medicine will diagnose you based on signs and symptoms, a physical examination and diagnostic tests that may include:

• Computed tomography (CT) scan: This test can show bleeding in the brain or damage to brain cells caused by a stroke, and may also reveal any brain conditions that may have caused the symptoms.
• Magnetic resonance imaging (MRI): Images from this test can reveal changes in brain tissue from the stroke.
• CT or MR arteriograms: These imaging tests can show the large blood vessels in the brain, as well as reveal the flow of blood through the brain or the size of a blood clot.