What is a hemorrhagic stroke?

Hemorrhagic strokes are caused by bleeding within the brain. They are more common than ischemic strokes, and cause approximately 20% of all strokes in the United States.

Hemorrhagic stroke is commonly known as a “bleeding stroke” or “brain hemorrhage.” The term “hemorrhagic” refers to bleeding, while the term “stroke” refers to damage to part of the brain caused by loss of blood flow.

The most common causes of hemorrhagic stroke are ruptured cerebral aneurysms (a balloon-like bulge in a weakened artery wall) and intracerebral hemorrhages (an abnormal collection of clotted blood vessels). Other causes include trauma to the head such as a blow to the head, skull fractures, and arteriovenous malformations (abnormal tangles of arteries and veins).

A hemorrhagic stroke is caused by bleeding in the brain. It’s less common than an ischemic stroke, but it can be just as serious. Hemorrhagic strokes are typically sub-categorized by where in the brain the bleeding occurs. The most common types of hemorrhagic strokes are:

• Intracerebral hemorrhage, or bleeding in the brain tissue itself
• Subarachnoid hemorrhage, or bleeding in the space between the brain and arachnoid membrane, which covers the brain and spinal cord
• Intraventricular hemorrhage, or bleeding inside one of the four ventricles of the brain (each ventricle is a large cavity within the brain)
• Intraparenchymal hemorrhage, or bleeding within a particular part of the brain

What causes a hemorrhagic stroke?

Hemorrhagic strokes are caused by ruptures in blood vessels in the brain. There are many different types of ruptures, but they all result in bleeding in the brain. The most common type of hemorrhagic stroke is caused by a rupture in an artery. The artery is a blood vessel that carries oxygen-rich blood to the brain, so when the artery ruptures, it causes bleeding into the surrounding tissue.

Hemorrhagic strokes can be broadly categorized as either intracerebral or intraparenchymal hemorrhages. Intracerebral hemorrhages occur within the cell body of a neuron, while intraparenchymal hemorrhages occur outside of the cell body. Almost all intracerebral hemorrhage cases are due to infarctions (blockages) that occur during thrombotic strokes. In contrast, only about 20 percent of intraparenchymal hemorrhages are due to infarction, and 80 percent are due to rupture of artery walls that supply blood to the brain.

What percentage of strokes are hemorrhagic?

The answer to this question depends on the patient’s age, sex, race and geographic area. The overall prevalence (percentage of total strokes) of hemorrhagic stroke is estimated at 20%. In patients over age 80 years, the prevalence may be as high as 35%. These rates are higher than in younger populations. Hemorrhagic stroke has been reported to occur in up to 60% of all strokes in Japanese populations and rarely in African Americans.

According to the National Stroke Association, approximately 81% of all strokes are ischemic. This means they are caused by an obstruction of blood flow to the brain, usually due to a clot. Though many people think that hemorrhagic strokes, in which there is bleeding into the brain tissue, account for most of the remaining 19%, this isn’t true. Hemorrhagic strokes account for only about 3% of strokes overall. All strokes should be taken seriously, though, because they can create long-term damage if not treated quickly.

Risk factors for stroke

A stroke can occur at any age, but risk factors for stroke generally increase with age. Strokes are more likely to occur in people over the age of 55 and can also be caused by stroke risk factors such as excessive alcohol consumption and lack of physical activity. Other stroke risk factors include:

• A history of a previous stroke or transient ischemic attack (TIA)
• Cocaine use
• Diabetes
• High blood pressure
• HIV/AIDS
• Infections
• Family history of strokes or heart disease
• Low level of high-density lipoprotein (HDL) cholesterol and triglycerides

Risk factors for hemorrhagic stroke

Hemorrhagic stroke is a type of stroke that is caused by bleeding in the brain. Many risk factors for hemorrhagic stroke are also risk factors for ischemic stroke, which is the other type of stroke that can occur. These shared risk factors include high blood pressure (hypertension), diabetes, smoking, and excessive drinking.

Dietary risks may also increase the chance of hemorrhagic stroke. High intake of salt (sodium) has been associated with an increased risk of hemorrhagic stroke. This is thought to be due to changes in blood pressure and volume. High intake of alcohol—particularly heavy drinking—has also been found to be positively associated with hemorrhagic stroke. Other dietary risks for hemorrhagic stroke include low intake of fruits and vegetables and low dietary fiber intake.

Vitamin C may have protective effects, as it has been linked with a lowered risk of hemorrhagic stroke in some studies.

Symptoms of hemorrhagic stroke

When a stroke occurs, it is an emergency. Treatment of hemorrhagic stroke is often different from treatment of the other types of strokes, but the symptoms are similar. The symptoms of a hemorrhagic stroke may include:

• An abrupt onset of severe headache, which may be accompanied by vomiting
• Severe back pain or neck pain
• Trouble seeing in one or both eyes
• Trouble speaking and understanding speech
• Numbness, weakness, or paralysis on one side of the body (usually beginning on one side of the face)
• A sudden change in mental status

Complications of hemorrhagic stroke

There are a number of complications that can result from a hemorrhagic stroke. The most common complications include respiratory failure, pneumonia, urinary tract infections, and gastrointestinal bleeding. The patient’s family will need to be prepared for these possible complications and know how to handle them. If the patient has difficulty breathing, the family may need to get suction to remove secretions from their mouth or throat or give them oxygen through a mask. If they have difficulty swallowing food or saliva, then they may need to be fed through a tube. Caregivers will often give the patient medications to prevent these complications.

The two most common types of strokes are ischemic and hemorrhagic strokes. Ischemic strokes occur when an obstruction prevents blood flow in the brain, while hemorrhagic strokes occur when a blood vessel bursts inside the brain or in the space around it. They are also sometimes referred to as cerebral infarctions and intracerebral hemorrhages respectively. Hemorrhagic strokes tend to have worse consequences than ischemic ones because of the damage done by the tissue swelling from bleeding, but they are also more treatable with medications and surgery (in some cases).

How to treat hemorrhagic stroke

Hemorrhagic strokes are the result of bleeding into the brain. Hemorrhagic strokes account for a third of all stroke cases and have a higher mortality rate than ischemic strokes. If a hemorrhagic stroke is left untreated, the patient can die within three hours. The emergency treatment for hemorrhagic stroke is intravenous recombinant tissue plasminogen activator (IV-rtPA) within 3 hours of onset. IV-rtPA works by dissolving blood clots, restoring blood flow to vital areas of the brain, and restoring functionality to that area of the brain which has been affected by the stroke.

The delivery of IV-rtPA requires the following:

1) A diagnosis of hemorrhagic stroke by CT scan, MRI or other imaging tool

2) An expedited trip to an emergency care facility with trained personnel on hand at all times for IV rtPA administration

3) IV equipment

4) Monitoring equipment (heart rate monitor, blood pressure monitor, EKG and blood oxygen monitor)

If these conditions are not met, patients may not be able to receive IV-rtPA due to regulations set forth by their doctor or health plan.

5) Close monitoring after receiving IV rtPA because side effects can occur.

Rehabilitation

Rehabilitation is a necessary part of recovery from a stroke. It improves the health of the affected area, helps to prevent further damage, and helps boost your physical abilities. While it’s important to note that everyone’s rehabilitation needs are different, there are some general ideas for how to get started on a rehabilitation plan.

The first thing you’ll need is a medical professional who can help you figure out what kind of rehab would be best for you. This may be your family doctor, or it could be someone at your local hospital or rehabilitation center. You’ll want to ask questions about what kind of exercises will be best for you, as well as how often they should be done and how long they should last. Your doctor will take care to ensure that your activity level is appropriate and that there are no other factors that are presenting challenges to your recovery.

Once you have a plan in place, make sure that your home environment supports it. For example, if you’re dealing with mobility issues after a stroke, don’t put any obstacles in your way—keep all furniture moved out of the way while you’re working on moving around more easily, make sure there aren’t any cords or toys on the floor that could trip you up, and so on.

Diagnosing hemorrhagic stroke

Hemorrhagic strokes are difficult to diagnose, because they look very similar to ischemic strokes, at least initially. One major way that doctors can tell the difference between the two is by taking a closer look at the brain’s blood vessels, using CT scans and MRIs. Hemorrhagic strokes, unlike ischemic strokes, occur when a blood vessel ruptures and bleeds into the surrounding tissue. This bleeding causes a brain hemorrhage and can lead to serious neurological problems such as coma, paralysis and death.

Hemorrhagic stroke symptoms are similar to those of other types of stroke—sudden numbness or weakness in one side of the body, slurred speech, confusion or loss of consciousness—but with a caveat: because hemorrhagic strokes are more likely to occur in older individuals who have preexisting health issues such as high blood pressure and diabetes, their symptoms might be attributed to other conditions such as a transient ischemic attack (TIA) or benign intracranial hypertension (BIH). Unlike TIA patients whose symptoms last less than 24 hours, people with BIH experience repeated episodes of increased intracranial pressure and can endure them for many months or even years before receiving treatment.

Preventing hemorrhagic stroke

• Lose weight if you’re overweight
• Control high blood pressure via diet and exercise (and if necessary, prescription medication)
• Don’t smoke or use tobacco products
• Eat a low fat, low cholesterol diet
• Exercise at least 30 minutes a day, 5 days a week

Hemorrhagic stroke in children

Hemorrhagic stroke in children is a rare condition, but when it does occur, it can cause devastating damage to the brain. It occurs when the blood vessels are torn and bleed into the surrounding brain tissue, damaging surrounding tissue and causing severe damage.

The symptoms for hemorrhagic stroke in children are rather similar to those for ischemic stroke in children, but an affected child will present with more severe neurological issues and may also have signs of intracranial bleeding through CT scans or MRI.

Treatment for hemorrhagic stroke in children will depend on the age of the patient, their condition upon diagnosis, and any other underlying health conditions they may have. For instance, a young child with no other complications would be treated differently than a teenager who has hemophilia.