Hemorrhagic Stroke

A stroke happens when part of the brain loses its blood supply. Without the oxygen and nutrients blood carries, brain cells start to die within a few minutes, which can lead to lasting brain damage, long-term disability or death.

Strokes come in two main types, ischemic and hemorrhagic. A hemorrhagic stroke is the less common of the two but is often more severe. It happens when a blood vessel in the brain bursts and bleeds (hemorrhages) into or around the brain. The bleeding raises the pressure inside the skull and damages brain tissue, and within minutes brain cells begin to die.

Types

Hemorrhagic strokes are grouped by where the bleeding occurs:

• Intracerebral hemorrhage, the most common type: bleeding directly into the brain tissue.
• Subarachnoid hemorrhage: bleeding into the space between the brain and the thin layers of tissue that cover it. This often happens when an aneurysm, a weak spot in an artery, bursts on the surface of the brain.

Causes

Common causes include:

• Aneurysm, a bulge or "balloon" in a weakened artery wall, which can burst.
• Arteriovenous malformation (AVM), a tangle of abnormal blood vessels that can rupture inside the brain.
• High blood pressure (hypertension), which over time can weaken the walls of blood vessels and make them more likely to break.
• Head injury, which can cause bleeding.

Warning signs

Stroke symptoms usually come on suddenly:

• numbness or weakness of the face, arm or leg, especially on one side of the body;
• confusion, or trouble speaking or understanding speech;
• trouble seeing in one or both eyes;
• trouble walking, dizziness, or loss of balance or coordination;
• a severe headache with no known cause.

The F.A.S.T. test is a quick way to remember what to look for:

• Face: one side droops when the person smiles.
• Arm: when both arms are raised, one drifts downward.
• Speech: words are slurred or strange.
• Time: call 911.

Diagnosis and treatment

A health care provider may examine the person, ask about symptoms and medical history, and use imaging tests to look for bleeding in the brain.

Stroke needs treatment as quickly as possible. With a hemorrhagic stroke, the first step is to find where the bleeding is coming from and stop it. That may mean medicines or, in some cases, surgery to stop the bleeding or ease pressure on the brain. Afterwards, rehabilitation can help people recover abilities they lost and regain their independence.

Prevention

The best way to prevent a stroke is to make heart-healthy lifestyle changes that lower the risk. If those are not enough, a provider may prescribe medicine to help control risk factors.

Sources

• MedlinePlus, U.S. National Library of Medicine, "Hemorrhagic Stroke." https://medlineplus.gov/hemorrhagicstroke.html
• MedlinePlus credits the information to the National Institute of Neurological Disorders and Stroke, NIH.