Hemorrhagic Stroke: What It Is, Symptoms, Causes, Treatment & Recovery

Hemorrhagic stroke makes up about one-third of all stroke cases. Here, we break down:

• What a hemorrhagic stroke is 

• What’s the difference between an ischemic and hemorrhagic stroke

• The symptoms of a hemorrhagic stroke

• The causes of hemorrhagic stroke

• What treatments are available 

• What the recovery process is like

A hemorrhagic stroke occurs when there is bleeding within the brain. This bleeding can manifest in various forms: 

• Blood outside the brain, known as subdural hematoma or epidural hematoma

• Blood within the brain, referred to as intraparenchymal hematoma

• Blood within the brain's covering, termed subarachnoid hemorrhage

Hemorrhagic stroke results from the rupture of a blood vessel, while an ischemic stroke stems from the blockage of a blood vessel. Ischemic strokes are more prevalent, accounting for two-thirds of stroke cases, whereas hemorrhagic strokes constitute the remaining one-third.

The symptoms of a hemorrhagic stroke are often sudden and may be preceded by warning signs. A useful mnemonic for recognizing these symptoms is BE FAST:

Balance: Sudden onset of balance problems, potentially presenting as vertigo, dizziness or difficulty walking.

Eyes: Sudden onset of vision problems, such as blurry vision, double vision or blindness.

Face: Sudden onset of facial issues, including numbness, tingling, weakness or drooping.

Arm: Sudden onset of arm problems, including numbness, tingling or weakness.

Speech: Sudden onset of speech problems, such as slurred speech, difficulty communicating or inability to understand.

Time: Time is crucial; it's vital to call 911 immediately upon experiencing any of these symptoms for prompt treatment and better outcomes.

The causes vary depending on the type of hemorrhagic stroke. For intraparenchymal hemorrhages (blood within the brain), high blood pressure is the most common cause. Other causes may include issues with blood vessels (such as aneurysms, arteriovenous malformations (AVMs) or vasculitis [inflammation of blood vessels]), a venous clot, or underlying tumors or coagulopathies induced by medications (like aspirin, clopidogrel, apixaban or warfarin) or underlying liver disease. 

Subarachnoid hemorrhages (blood within the brain's covering) are typically linked to aneurysms, which is a ballooning of a blood vessel with a weakened wall.  

As the medical director of stroke at Northwestern Medicine Delnor Hospital, stroke treatment aims to minimize the impact of the stroke, aid in patient recovery and prevent future occurrences. Immediate action is crucial, emphasizing the importance of calling 911 at the onset of symptoms. 

Treatment strategies may involve: 

• Medication to reduce bleeding and swelling

• Blood pressure management

• Reversal of coagulopathy

• Cessation of blood-thinning medications

• Procedures such as external ventricular drainage or surgical intervention to remove hematomas

Addressing underlying vascular pathologies, such as aneurysms or AVMs, may necessitate either with endovascular procedures (such as aneurysm coiling, or AVM embolization) or open surgical procedures (such as surgical clipping, or surgical resection of AVM).  

It is important to remember that when you have symptoms of stroke, do not take aspirin because it may worsen the hemorrhagic stroke.  

Stroke recovery varies based on factors like age, the size and location of the stroke, and the individual's commitment to rehabilitation. Recovery isn't solely physical; it encompasses mental, emotional, social, financial and occupational aspects. Multidisciplinary care involving physical therapists, occupational therapists, speech therapists, rehabilitation physicians, social workers, case managers, counselors and neuropsychologists is essential. 

Additionally, support from family and friends plays a crucial role. Emphasizing brain health through nutrition, rest, hydration, sleep and emotional support is integral to the recovery journey.

For more information on stroke, check out these additional resources:

Stroke: What It Is, Types, Symptoms, Causes, Risk Factors, Treatment & Prevention

Ischemic Stroke: What It Is, Symptoms, Causes, Treatment & Recovery

Transient Ischemic Attack (TIA): What It Is, Symptoms, Causes, Treatments & Recovery

Caregiving for Someone After a Stroke