hemorrhagic stroke

Hemorrhagic Stroke 101: Symptoms, Causes & Treatment

Learn all about hemorrhagic stroke including its symptoms, causes, treatment, prevention and management.

by Lorraine Bunag, R.N.

One study titled, 5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore, reported that 59.3% of more than 12,500 participating stroke patients survived within five years. However, 18.4% were rehospitalized due to stroke recurrence in the same period. What is hemorrhagic stroke, and why does it pose so much threat to a person’s health and well-being?

What is Hemorrhagic Stroke?

Before we move further into the discussion about hemorrhagic stroke, let’s first define the condition. 

A stroke happens when a part of the brain doesn’t receive enough oxygen. It has three main types: ischemic, which occurs due to blockage in the blood supply, transient, which means the blood supply is blocked, but only for a short time, and hemorrhagic, which involves bleeding. 

To further explain, hemorrhagic stroke occurs when a blood vessel in the brain, particularly an artery, breaks open (ruptures) and then leaks blood. The leaked blood puts pressure on the brain cells, eventually damaging them. 

Hemorrhagic Stroke vs. Ischemic Stroke

To quickly differentiate hemorrhagic stroke from ischemic stroke, remember that hemorrhage (hemorrhagic) pertains to bleeding, and ischemia (ischemic) indicates a blocked blood flow. Both conditions may lead to oxygen deprivation in some parts of the brain. 

Two Types of Hemorrhagic Stroke

According to Harvard Health, hemorrhagic stroke accounts for 20% of all stroke cases. Its two types depend on where the leak happened:

Intracerebral Hemorrhage

This indicates that the blood leak happened within the brain. Please note that other types of stroke, such as an ischemic stroke due to thrombus or blood clot (thrombotic stroke), can quickly become a hemorrhagic stroke. 

Subarachnoid Hemorrhage

This type of hemorrhagic stroke pertains to bleeding on the brain’s surface. The leaked blood then fills the space between the brain and skull, mixes with the cerebrospinal fluid, and puts pressure onto the brain, causing damage. 

Hemorrhagic Stroke Symptoms

Spotting the signs of stroke is crucial. The sooner hemorrhagic stroke treatment begins, the fewer the brain damage is. This means prompt treatment increases the chance of better long-term outcomes. 

When it comes to stroke, reports say the symptoms generally occur out of nowhere. Someone who’s having a stroke might develop sudden trouble in speaking, seeing, and walking due to loss of balance or coordination. They might also have sudden dizziness, severe headache, and numbness on the face, arm, leg, or one side of the body. 

To be more specific, below are the signs of intracerebral and subarachnoid hemorrhages:

  • A sudden, intense headache
  • Loss of balance or coordination
  • Changes in vision
  • Loss of speech or trouble understanding speech
  • Seizures
  • Weakness or numbness in an arm or leg; some patients also report inability to move a limb. 
  • Nausea or vomiting
  • Lack of alertness or confusion
  • Loss of consciousness

Additional Signs and Symptoms to Watch Out For

  • Sensitivity to light
  • Unusual taste in the mouth
  • Neck pain or stiff neck
  • Paralysis of one side of the body
  • Frequent fluctuations in the heart or breathing
  • Difficulty swallowing or dysphagia
  • Hand tremors

If you experience these hemorrhagic stroke symptoms or notice them on your loved ones, act quickly. Go to the nearest hospital to get checked and receive hemorrhagic stroke treatment when needed. 

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Hemorrhagic Stroke Causes

According to a recently updated paper, two major hemorrhagic stroke causes are hypertension and cerebral amyloid angiopathy (CAA). 


The same report stated that long-standing hypertension is the most common cause of hemorrhagic stroke. However, there are also cases when hypertensive changes or acute hypertension, such as when a pregnant woman experiences eclampsia, lead to intracranial hemorrhage. 

Cerebral Amyloid Angiopathy

CAA occurs when proteins called amyloids build up in the walls of the arteries in the brain. The risk of CAA increases with age. In fact, the paper said around 50% of adults aged 70 and up have the condition. Experts say it may also run in the families. Please note that familial CAA may affect younger people. 

Hemorrhagic Stroke Risk Factors

Besides hypertension and cerebral amyloid angiopathy, the following are also hemorrhagic stroke risk factors:

  • Advanced age
  • Being male
  • Cigarette smoking
  • Moderate to heavy alcohol consumption and chronic alcoholism
  • Certain conditions, like cerebral aneurysm, blood and bleeding disorders, or liver disease. 
  • Dual platelet antiplatelet therapy
  • Low levels of low-density lipoprotein or good cholesterol and low triglycerides
  • Intake of certain drugs, such as cocaine, amphetamine, phenylpropanolamine, and ephedrine. 
  • Cerebral microbleeds or long-term accumulation of blood products in brain tissue. 
  • Certain tumors, like lymphoma, glioblastoma, or pituitary adenoma. 
  • Blood thinners. People at risk of ischemic stroke may receive blood thinners; however, these medications increase the risk of hemorrhagic stroke. 

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Hemorrhagic Stroke Diagnosis

Before hemorrhagic stroke treatment begins, the patient must first undergo diagnostic tests. Standard assessment procedures include imaging tests such as computerized tomography (CT) scan and magnetic resonance imaging (MRI) scan. These scans show bleeding in the brain and help identify the kind of stroke. 

The doctor might also order an electroencephalogram, a procedure that detects electrical activity in the brain. It gives information about brain function. 

The patient may also need additional tests, such as blood tests and lumbar puncture. 

Hemorrhagic Stroke Treatment

Like mentioned, prompt hemorrhagic stroke treatment is crucial not just to save the patient’s life but also to minimize brain damage. The initial goal of treatment is to stop the bleeding and reduce pressure. 

Hemorrhagic stroke treatment depends on several factors, like the location of bleeding, how severe the bleeding is, and what caused it. Below are some of the common strategies in treating hemorrhagic stroke:

Blood Pressure Management

Hypertension must be dealt with with care. In cases of hemorrhagic stroke, reducing high blood pressure should happen gradually. This typically requires medication such as beta-blockers, ACE inhibitors, and calcium channel blockers. 

Attending to Increased Intracranial Pressure

Immediately after hemorrhagic stroke diagnosis, the medical team will impose measures to relieve intracranial pressure. Some of the most common ways to reduce pressure are raising bed to 30 degrees and introducing osmotic agents such as mannitol or hypertonic saline. 


It’s common for a hemorrhagic stroke patient to undergo surgery to stop the bleeding and remove the pressure in the brain. The surgeon will perform a craniotomy to open a small portion of the skull where the bleeding is present. 

During the operation, the surgeon will remove the excess blood and seal the leaking blood vessel. If the cause of stroke is a cerebral aneurysm or a problematic blood vessel, the surgery will also help prevent future stroke incidences from happening. When needed, the doctor might also redirect blood flow within the brain to ensure that all parts will receive adequate blood supply. 

Antiepileptic Measures

Because seizures sometimes happen to stroke patients, antiepileptic drugs might be a part of hemorrhagic stroke treatment. Continuous electroencephalogram might also be needed, especially for patients with a decreased level of consciousness. 

General Care

Since hemorrhagic stroke may result in several physical effects, such as cardiac arrhythmia, dysphagia, gastrointestinal bleeding, acute kidney injury, and urinary tract infections, general nursing and medical care are crucial aspects of hemorrhagic stroke management. 

Hemorrhagic Stroke Complications

Regardless of type, the consequences of a stroke depend on the extent of damage in the brain. Below are some of the potential complications of hemorrhagic stroke:

  • Dangerous blood clots. When stroke renders the patient bedridden, the lack of activity may increase the risk of having blood clots in the legs. Remember that the blood clot may break free and travel to other parts of the body, such as the lungs. 
  • Lack of movement also increases the risk of developing bedsores
  • Loss or reduced sense of sight, hearing, and touch. Complications such as these may eventually affect how the patient performs activities of daily living, like driving, cooking, and reading. 
  • Trouble speaking, which usually complicates communication. 
  • Loss of bowel and bladder control. Effects like these might require catheter use, which in turn increases the risk of urinary tract infections. 
  • Loss of bone and muscle strength.
  • Difficulty swallowing. Not only does dysphagia result in eating difficulties, but it also increases the risk of aspiration pneumonia when the patient inhales food and drinks. 
  • Swelling in the brain. 
  • Seizures.
  • Problems in language and cognitive aspects. 
  • Challenges in mental health, like anxiety and depression. 

Please note that some of these complications will get better with hemorrhagic stroke recovery and rehabilitation. For instance, undergoing physical therapy usually helps increase bone and muscle strength and improves the capacity to move. 

Hemorrhagic Stroke Recovery and Rehabilitation

After the initial hemorrhagic stroke treatment took care of the bleeding and intracranial pressure, the next step is rehabilitation.

Of course, the type of rehabilitation a person needs depends on the consequences they experienced. Those with minimal brain damage who received immediate hemorrhagic stroke treatment may recover fully. However, recovery may take weeks, months, or even years. On the other hand, some patients may sustain life-long complications even after rehab. 

Nevertheless, the sooner one starts their hemorrhagic stroke recovery and rehabilitation, the better. 

This is to make the most of the “window of enhanced neuroplasticity,” a period when the brain is more likely to respond to rehab strategies. Doing the rehabilitation in that window might make it particularly effective. 

Below are the potential rehab strategies:

Speech-Language Therapy to Improve How the Patient Communicates

The speech therapist will help the patient use the right words, pronounce them correctly, and string them together to make sense. Speech-language therapy might also help with memory problems. 

Physical and Occupational Therapy

Physical therapy helps with improving bone and muscle strength and movement. This is especially beneficial for those with paralysis or weakness. Occupational therapy teaches the patient new ways to do routine activities safely and more efficiently. 

Bowel and Bladder Training

If the patient develops issues in their bladder and bowel habits, they might need the help of a urologist or bowel specialist. Sometimes, they also need to take medications for them. 

Healthy lifestyle changes are, of course, necessary for hemorrhagic stroke recovery. Moving forward, the patient needs to work closely with the healthcare team to have a healthy diet, appropriate physical activity, adequate rest, and a manageable level of stress. Taking all the medicines as prescribed, quitting smoking, and weight management are also top priorities. 

Monitoring one’s condition is crucial. The patient must always show up for check-ups and inform the doctor when unexpected signs and symptoms occur. 

Many people also find comfort and relief in joining support groups where they can safely share their feelings and challenges regarding stroke incidence. Here’s a list of Stroke Support Groups you can join in. 

Hemorrhagic Stroke Prevention 

There’s no one sure way to prevent any stroke from happening. However, you can reduce your risk by attending to or eliminating conditions that may lead to hemorrhagic stroke. 

Case in point, since hypertension is the most common cause of hemorrhagic stroke, it would be incredibly beneficial to lower your blood pressure levels. To reach your blood pressure goals, you need your doctor’s guidance, especially for required medicines. 

Additionally, if you have other contributing conditions, such as cerebral aneurysm and blood disorders, attending to them as quickly as possible should be a priority. 

To further reduce your risk, try to adhere to healthy lifestyle practices. These include:

  • Healthy diet. Reduce your intake of saturated fats and ultra-processed foods. Be sure to have adequate servings of whole grains, fruits, vegetables, and lean protein. 
  • Avoid or quit smoking. Cigarette smoking is a risk factor for many other conditions, like heart diseases and cancer. 
  • Maintain a healthy weight. Excessive weight is a considerable factor in hypertension. To manage your weight, having appropriate and regular exercise is essential. 
  • Avoid recreational drugs and limit your alcohol intake since they increase your risk of hemorrhagic stroke. 

Do you feel that you or your loved ones are at risk of experiencing a hemorrhagic stroke? If that’s the case, set an appointment with a doctor. You can talk to them about your risk factors, and they can guide you on the most effective ways to control them. 

Not yet ready to go to a clinic or hospital? Consider consulting a physician online. Likewise, you can also have a House Call Doctor visit you at home.

Also, are you looking for someone to care for your loved ones? Homage provides caregiving services at every stage. Our trained care professionals are able to provide companionship, nursing care, night caregiving, home therapy and more, to keep your loved ones active and engaged. 

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  1. 5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore. (n.d.). PubMed. Retrieved May 16, 2021, from https://pubmed.ncbi.nlm.nih.gov/24088308/
  2. Early rehabilitation after stroke: A narrative review. (7, November). PubMed Central (PMC). Retrieved May 16, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802378/#:~:text=Purpose%20of%20Review&text=There%20is%20a%20window%20of,rehabilitation%20might%20be%20particularly%20effective
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About the Writer
Lorraine Bunag, R.N.
Lorraine is a registered nurse who spends most of her time writing informative articles on health and wellness. At the end of the day, she relaxes by reading a book or watching documentaries about unsolved mysteries.
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