Hemorrhagic Stroke

A hemorrhagic stroke occurs when a blood vessel in the brain bursts and spills blood into or around the brain. This may be caused by high blood pressure or aneurysms that can make blood vessels weak enough to burst.

There are two types of hemorrhagic stroke. These are intracerebral and subarachnoid hemorrhagic strokes.
The classification is based upon the cause of the bleeding and region in which the bleeding begins. Treatment differs for each kind of hemorrhagic stroke.

Intracerebral Hemorrhage

An intracerebral hemorrhage can occur when a burst blood vessel bleeds into the brain tissue.The bleeding causes brain cells to die and the part of the brain that is affected stops working correctly. High blood pressure is the most common cause of this type of stroke.

intracerebral hemorrhage

Intracerebral hemorrhage | Source: Emaze

Symptoms: A feature common to most ICH cases is a sudden onset of symptoms. However, the signs that accompany this type of stroke are not always the same. Depending on the location and amount of bleeding in the brain, ICH symptoms may include:

  • Partial or total loss of consciousness
  • Vomiting or severe nausea, when combined with other symptoms
  • Sudden numbness or weakness of face, arm or leg, especially on one side of the body
  • Sudden severe headache with no known cause

Treatment: Treatment of ICH involves a variety of medical and surgical techniques, depending on the exact cause and size of the stroke. In cases where ICH is caused by high blood pressure, doctors try to reduce the blood pressure. They then address the swelling or pressure that often builds up inside the head after the blood vessel ruptures. In some cases, surgery may be needed to limit the damage to brain cells.

Call 911 if you see or have any of these symptoms. Treatment can be more effective if given quickly.

Subarachnoid Hemorrhage

A subarachnoid hemorrhage occurs when a blood vessel bursts near the surface of the brain and blood leaks in between the brain and the skull. This blood may cause nearby arteries to spasm, and that reduces blood flow to the brain and causes a stroke.

This type of stroke can be caused by different things, but is usually caused by a burst aneurysm. An aneurysm is a weak spot on the wall of an artery that bulges out into a thin bubble. As it gets bigger, the wall may weaken and burst. If it bursts, blood leaks inside or around the brain.

Subarachnoid hemorrhage

Subarachnoid hemorrhage | Source: American Stroke Association

Symptoms:Typically, there are no warning signs of a SAH. Occasionally, an aneurysm is detected through a warning leak. These small leaks may cause headaches prior to a more damaging SAH. The symptoms of a SAH include:

  • Sudden severe headache – often described as the “worst headache of my life”
  • Vomiting or nausea, especially when combined with other symptoms such as headache
  • Intolerance to light
  • Stiff neck
  • Loss of consciousness, especially when combined with a severe headache

Treatment: Treatment of SAH targets the cause of bleeding and its related complications. Ruptured aneurysms are generally repaired through direct surgery to clip the aneurysm or treating the aneurysm from inside the vessel. Operating on the aneurysm from the inside, called embolization, is done by guiding a small metal coil through the brain artery until it reaches the aneurysm. Once there, the coil allows for a clot to form and prevent more blood from entering. A vessel-narrowing condition called vasospasm is also a common cause of death and disability following a SAH. Vessels in vasospasm become irritated by blood and begin to spasm.

As the vessels narrow, it becomes more difficult to supply surrounding brain tissue with enough blood to survive. This condition occurs in at least thirty percent of all subarachnoid hemorrhages. It generally lasts for two or more weeks after the first vessel rupture. Vasospasm treatment often includes the use of the oral medication, nimodipine. Taking the medication exactly as prescribed is critical to control the condition. Doctors may also manage vasospasm by closely monitoring the pressure, volume and concentration of blood in the brain.