Hemorrhagic stroke

A hemorrhagic stroke occurs when a blood vessel bursts (hemorrhages) and bleeds into or onto the brain. This deprives the brain cells of vital oxygen and nutrients and compresses brain tissue. Of the 795,000 strokes each year in the United States, about 15 percent are hemorrhagic. The rest are ischemic – caused by the blockage of blood vessels to or within the brain. Hemorrhagic stroke is an extremely serious condition that is often fatal.

Types of hemorrhagic stroke

There are two types of hemorrhagic stroke: intracerebral hemorrhage and subarachnoid hemorrhage. The main difference between the two is where the hemorrhage occurs.

Intracerebral hemorrhage, the most common type, occurs when a blood vessel bursts inside the brain. High blood pressure, aging blood vessels, or arteriovenous malformation – a tangle of deformed blood vessels -- can cause this.
Subarachnoid hemorrhage occurs in the subarachnoid space -- the area inside the skull just outside the brain. Usually, an aneurysm, a bulge in the weakened wall of an artery, ruptures, filling the subarachnoid space with blood and applying pressure on the brain. Other causes can include a head injury, blood thinners, or arteriovenous malformation also can contribute.

Risk factors

Some factors that make a person more likely to have a stroke are beyond his or her control, but other risk factors can be controlled, if not eliminated. These include:

High blood pressure (the No. 1 risk factor)
Diabetes
Obesity
Smoking
Heart disease

Learn more about lowering the risk of stroke »

Signs & symptoms

Treat a stroke, or even the appearance of a stroke, as a life-threatening emergency and call 911. Quick treatment is crucial to prevent brain damage. A person who is having a stroke might experience:

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

Think BE-FAST*

Balance: Is the person having trouble walking? Loss of balance or coordination, dizziness.
Eyes: Is the person having trouble seeing? Change in vision in one or both eyes.
Face: Ask the person to smile. Does one side of the face droop?
Arms: Ask the person to raise both arms. Does one arm drift downward?
Speech: Ask the person to repeat a simple phrase. Is speech slurred or strange?
Time: Call 911 – Stroke is frequently preventable and treatable, but you need to get help quickly.
*BE-FAST was developed by Intermountain Healthcare, as an adaptation of the FAST model implemented by the American Stroke Association. Reproduced with permission from Intermountain Healthcare. Copyright 2011, Intermountain Healthcare.

Learn more about recognizing a stroke and what to do »

Treatment

The immediate goal of treatment is to stop the bleeding. One of two procedures might be used:

Coil embolization: A catheter is inserted into an artery in the groin and threaded through the vascular system to the source of the bleeding. A metal coil is then pushed into the site of the rupture. This blocks the rupture and prevents it from reopening.
Aneurysm clipping: an incision is made in the brain, and a clamp is inserted at the base of the aneurysm.

Also, a hole might be drilled in the skull to relieve pressure.

Outlook

Ruptured brain aneurysms are fatal about 40 percent of the time, and about 66 percent of survivors suffer permanent neurological damage, according to the Brain Aneurysm Foundation. About 15 percent of those with subarachnoid hemorrhage from an aneurysm die before reaching the hospital.

Medication, physical and/or occupational therapy, speech therapy and counselling all might be involved during recovery from stroke. According to the American Stroke Association, recovery from a stroke depends on a number of factors:

Where in the brain the stroke occurred
How much of the brain was affected
The patient’s motivation
Caregiver support, the quantity and quality of rehabilitation
How healthy the survivor was before the stroke

The National Stroke Association says that about 795,000 Americans have a stroke each year, and that of those, at least 1 in 4 will have another stroke within their lifetime. That means managing risk factors is crucial for stroke survivors.