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Hemorrhagic Stroke

Definition

Stroke is a brain injury caused by an interruption in blood flow. Brain tissue that does not get oxygen and nutrients from blood can die within minutes. The damage to the brain can cause a sudden loss in bodily functions. The types of function that are affected will depend on the part of the brain that is damaged.

Two blood flow problems can cause a stroke:

  • A hemorrhagic stroke is caused by a ruptured blood vessel. It may be:
    • Intracerebral hemorrhage—bleeding in the brain
    • Subarachnoid hemorrhage —bleeding in the tissue around the brain
  • An ischemic stroke is caused by a blocked blood vessel.
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Causes    TOP

This stroke happens because of a weakened blood vessel in the brain. Blood vessels may be weakened by:

  • Abnormality in blood vessel structure
  • Arterio-venous (AV) malformation—an abnormal knot of blood vessels
  • Aneurysm—a weakened spot in a blood vessel wall
  • Other illness or medical problems like hypertension
  • Damage from trauma like a blow to the head or car accident

Risk Factors    TOP

Factors that may increase your chance of stroke include:

  • Gender: Men are more likely to have a stroke than women
  • Age: Risk of stroke increases with age particularly after 55 years of age
  • Family history of stroke

Factors that can weaken your blood vessels and raise your risk of hemorrhagic stroke include:

Blood disorders or medications can make it harder for you blood to clot. This can also increase your risk of a hemorrhagic stroke.

Symptoms    TOP

Symptoms will depend on the part of the brain affected. Rapid treatment is important to decrease the amount of brain damage. Call for emergency medical services right away if you have:

  • Sudden weakness or numbness of face, arm, or leg, especially on one side of the body
  • Sudden confusion
  • Sudden trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden lightheadedness, trouble walking, loss of balance, or clumsiness
  • Sudden severe headache with no known cause
  • Loss of consciousness

Other symptoms that may go along with the above symptoms include:

Diagnosis    TOP

A physical exam will be done. The doctor will look for muscle weakness, visual and speech problems. If possible, the doctor will ask about your symptoms and medical history. A CT scan may be done to confirm the diagnosis.

Images of blood vessels will help to find the cause of the bleeding. Image tests may include:

Blood tests will also be done. Tests will show how well the blood can clot. Your doctor may also examine the fluid that surrounds your brain and spine.

Treatment    TOP

Brain tissue without blood flow dies quickly. Immediate treatment is needed to stop the bleeding and relieve pressure on the brain.

Medicine

You may be given medicine to help your blood clot. This may also include vitamin K. It may be needed if you were taking medicine to reduce clots.

You may also be given medicine to help:

  • Decrease pressure in your brain
  • Prevent seizures
  • Lower blood pressure

Surgery

Surgery may be done to help stop the bleeding. Some may be done through catheters. The catheter is placed into blood vessels of the groin and passed to the vessels in the brain.

Options will depend on the cause and site of the bleeding:

  • For a burst aneurysm—A clip may be placed just before the damaged vessel. It should stop the bleeding.
  • For a leaking or aneurysm that has not burst—A special coil may be placed in the weak area. The coil will help a clot to form over the area. It will prevent bleeding. A clip may be used instead of a coil.
  • For an abnormal tangle of blood vessels—Surgery may be done to repair the blood vessels. It may be able to remove the tangles or reroute the blood around the area.

The stroke and damaged tissue can cause swelling in the brain. Surgery may be needed to relieve the pressure. One common option is to remove a section of the skull. This is called a craniotomy.

Rehabilitation    TOP

Recovery will depend on the amount of brain damage. Rehabilitation may include:

  • Physical therapy—to regain as much movement as possible
  • Occupational therapy—to assist in everyday tasks and self-care
  • Speech therapy—to improve swallowing and speech challenges
  • Psychological therapy —to improve mood and decrease depression

Prevention    TOP

Understand what risk factors you may have for stroke. Manage and monitor medical conditions that that increase your risk. This includes aneurysms and high blood pressure.

Other habits that may reduce your risk of stroke include:

  • Get regular exercise.
  • Eat more fruits, vegetables, and whole grains.
  • Limit salt and fat in your diet.
  • If you smoke, talk to your doctor about ways to quit.
  • Maintain a healthy weight.
  • Limit alcohol. This means no more than 2 drinks per day for men and 1 drink per day for women.
  • Check blood pressure often. Follow your doctor's advice for keeping it in a safe range.
  • Do not use recreational drugs, such as cocaine.

RESOURCES:

American Heart Association
http://www.heart.org
National Stroke Association
http://www.stroke.org

CANADIAN RESOURCES:

Heart & Stroke Foundation
http://www.heartandstroke.ca
Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References:

Hemorrhagic strokes (bleeds). American Heart Association American Stroke Association website. Available at:
...(Click grey area to select URL)
Updated May 21, 2018. Accessed June 14, 2018.
Hemorrhagic stroke. The Children’s Hospital of Philadelphia website. Available at:
...(Click grey area to select URL)
Accessed June 14, 2018.
Hemorrhagic stroke. National Stroke Association. Available at:
...(Click grey area to select URL)
Accessed June 14, 2018.
Intracerebral hemorrhage. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated February 26, 2018. Accessed June 14, 2018.
Liotta EM, Prabhakaran S, Sangha RS, et al. Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage. Neurology. 2017;89(8):813-819.
Stroke (acute management). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated March 19, 2018. Accessed June 14, 2018.
Stroke treatments. American Heart Association American Stroke Association website. Available at:
...(Click grey area to select URL)
Accessed June 14, 2018.
Subarachnoid hemorrhage. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated June 6, 2018. Accessed June 14, 2018.
8/11/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Molnar MZ, Mucsi I, Novak M, et al. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax. 2015;70(9):888-895.
1/18/2017 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Emdin CA, Odutayo A, Wong CX, Tran J, Hsiao AJ, Hunn BH. Meta-analysis of anxiety as a risk factor for cardiovascular disease. Am J Cardiol. 2016;118(4):511-519.
Last reviewed June 2018 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 6/14/2018

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