A hemorrhagic stroke occurs when blood from an artery suddenly begins bleeding into the brain. As a result, the part of the body controlled by the damaged area of the brain cannot work properly.
There are two main types of hemorrhagic stroke:
- Intracranial hemorrhages, when the bleeding occurs inside the brain
- Subarachnoid hemorrhages, when the bleeding occurs between the brain and the membranes that cover it
When the stroke is caused by a blockage in an artery that reduces blood flow to the brain, this is known as an ischemic stroke.
A person experiencing symptoms of a stroke needs immediate emergency care. The sooner medical treatment begins, the fewer brain cells are damaged.
The signs of a stroke are:
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion
- Sudden trouble speaking
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking
- Sudden dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
Symptoms of intracranial hemorrhages and subarachnoid hemorrhages include:
- A sudden, severe headache
- Changes in vision
- Loss of balance or coordination
- Weakness, inability to move or numbness in an arm or leg
- Loss of speech or difficulty understanding speech
- Confusion or loss of alertness
- Nausea and vomiting
- Loss of consciousness
Additional symptoms may include:
- Paralysis of one side of the body
- Sensitivity to light
- Stiffness in the neck or neck pain
- Frequent fluctuations in the heart beat and breathing
- Hand tremors
- Difficulty swallowing
- Abnormal taste in the mouth
Causes and Risk Factors
Hemorrhagic stroke is caused by sudden bleeding from a blood vessel inside the brain or in the spaces around the brain. Sudden bleeding may result from:
- Head injuries
- Cerebral aneurysm
- High blood pressure
- Blood vessel abnormalities, such as arteriovenous malformation (AVM) or amyloid angiopathy
- Blood or bleeding disorders, such as sickle cell anemia
- Liver disease
- Brain tumor
- Drug abuse
Uncommon causes of hemorrhagic stroke include inflamed blood vessels or radiation treatments.
Diagnosis of a hemorrhagic stroke is based on a thorough medical history and physical exam, and doctors may strongly suspect bleeding inside the skull based on the patient’s symptoms.
In cases where a stroke is suspected, imaging tests can help determine whether the stroke was caused by a clot (ischemic stroke) or by bleeding inside the brain (hemorrhagic). Imaging tests include magnetic resonance imaging (MRI) or computed tomography (CT) scans. An electroencephalogram (EEG) or lumbar puncture (spinal tap) may be done to confirm the diagnosis of a hemorrhagic stroke.
Tests may be done to check for other conditions, check the patient’s overall health, and see if the patient's blood clots too easily.
Patients who have symptoms of a hemorrhagic stroke need to seek immediate emergency medical care. Prompt medical attention may prevent life-threatening complications and more widespread damage to the brain.
Treatment for a hemorrhagic stroke depends on what caused it, where it's located and the size of the hemorrhage. Treatment options include interventional radiology or neurosurgical procedures, such as surgical clipping or coil embolization, which may also be performed to stop the bleeding and reduce the pressure in the brain. Medicines to reduce swelling, prevent seizures and reduce pain also may be given.
The goals of treatment are to prevent life-threatening complications that may occur soon after stroke symptoms develop, prevent future strokes, reduce disability, prevent long-term complications and help the patient get back as much normal functioning as possible through rehabilitation.
Cedars-Sinai has a range of comprehensive treatment options.