Hemorrhagic Stroke

What Is It?

A hemorrhagic stroke is bleeding (hemorrhage) that suddenly interferes with the brain's function. This bleeding can occur either within the brain or between the brain and the skull. Hemorrhagic strokes account for about 20% of all strokes, and are divided into categories depending on the site and cause of the bleeding:

  • Intracerebral hemorrhage — Bleeding occurs from a broken blood vessel within the brain. Some things that increase your risk for this kind of hemorrhage are high blood pressure (hypertension), heavy alcohol use, advanced age and the use of cocaine or amphetamines.

    Other kinds of stroke can convert to an intracerebral hemorrhage. For example, a stroke that begins without hemorrhage (a thrombotic or embolic stroke) can lead to intracerebral hemorrhage shortly afterward. This is especially common for embolic strokes that are related to a heart valve infection (endocarditis). In this case, a clump of bacteria and inflammatory cells from the valve infection can become a floating mass within the bloodstream (called an embolus). The infected clump can travel into a brain artery and become wedged there. Then, the infection can spread through the artery.

    In rare cases, intracerebral hemorrhage may happen because of a leaking arteriovenous malformation (AVM), which is an abnormal and weak-walled blood vessel that connects an artery and a vein. This weak blood vessel is present from birth—it is larger than a capillary so blood that flows in can be at high pressure, causing the AVM to eventually stretch or leak.

  • Subarachnoid hemorrhage — Bleeding from a damaged blood vessel causes blood to accumulate at the surface of the brain. Blood fills a portion of the space between the brain and the skull, and it mixes with the cerebrospinal fluid that cushions the brain and spinal cord. As blood flows into the cerebral spinal fluid, it increases pressure on the brain, which causes an immediate headache. In the days immediately following the bleeding, chemical irritation from clotted blood around the brain can cause brain arteries that are near to this area to go into spasm. Artery spasms can damage brain tissue. Most often, a subarachnoid hemorrhage happens because of a leaking saccular aneurysm (a sack-like bulge in the wall of an artery), but it also can occur because of leakage from an arteriovenous malformation.

Symptoms

Symptoms of a hemorrhagic stroke vary, depending on the cause:

  • Intracerebral hemorrhage — Symptoms almost always occur when the person is awake. Symptoms tend to appear without warning, but they can develop gradually. Symptoms worsen over a period of 30 to 90 minutes. Symptoms can include:

    • Sudden weakness

    • Paralysis or numbness in any part of the body

    • Inability to speak

    • Inability to control eye movements correctly

    • Vomiting

    • Difficulty walking

    • Irregular breathing

    • Stupor

    • Coma

  • Subarachnoid hemorrhage — When caused by a ruptured aneurysm, symptoms can include:

    • A very severe headache that starts suddenly (Some people describe it like a "thunderclap.")

    • Loss of consciousness

    • Nausea and vomiting

    • Inability to look at bright light

    • Stiff neck

    • Dizziness

    • Confusion

    • Seizure

    • Loss of consciousness

Diagnosis

Your doctor will want to know your medical history and your risk factors for stroke. Your doctor will take your blood pressure and examine you, including a neurological exam and a heart exam.

To continue reading this article, you must login.
  • Research health conditions
  • Check your symptoms
  • Prepare for a doctor's visit or test
  • Find the best treatments and procedures for you
  • Explore options for better nutrition and exercise
Learn more about the many benefits and features of joining Harvard Health Online »