Hemorrhagic Stroke

Causes

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

• Problems with the structure of a blood vessel
• 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

Things that may raise the risk of stroke include:

• Men are more likely to have a stroke than women
• Being 55 years of age or more
• Family history of stroke

Things that can raise a person's risk of hemorrhagic stroke include:

• High blood pressure
• Smoking
• Sleep apnea
• Cocaine use
• Alcohol use disorder
• Blood disorders or medicine that can make it harder for the blood to clot.

Symptoms

Symptoms will depend on the part of the brain that is affected. Getting medical help right away is key to reducing the amount of brain damage. Call for emergency medical services right away if someone suddenly has:

• Weakness or numbness of face, arm, or leg, especially on one side of the body
• Confusion
• Trouble speaking or understanding
• Trouble seeing in one or both eyes
• Lightheadedness, trouble walking, loss of balance, or clumsiness
• Severe headache with no known cause
• Loss of consciousness

Other symptoms a person may have are:

• Neck stiffness
• Nausea or vomiting
• Sensitivity to light

Diagnosis

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

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

• MR angiography
• CT angiogram
• Doppler ultrasound

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

Treatment

Brain tissue without blood flow dies quickly. Fast treatment is needed to stop the bleeding and get blood flowing to the brain again. Blood spilled in the brain is also trapped in the skull. It can put pressure on the brain. That pressure may need to be eased.

Medicine

Medicine can be given to help the blood clot. This may also include vitamin K. Medicine can also help:

• Ease pressure in the brain
• Prevent seizures
• Lower blood pressure

Surgery

Surgery may be done to help stop the bleeding. Some may be done through blood vessels. A tube is placed into blood vessels of the groin and passed to the vessels in the brain. Next steps 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 aneurysm that has not burst—A special coil or clip may be placed in the weak area. The coil will help a clot form over the area. It will prevent bleeding.
• 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 ease the pressure. One common way is to remove part of the skull. This is called a craniotomy.

Rehabilitation

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

• Physical therapy—to regain as much movement as possible
• Occupational therapy—to help with daily tasks and self care
• Speech therapy—to help with swallowing and speech issues
• Psychological therapy—to improve mood and decrease depression

Prevention

Manage and watch medical issues. This includes aneurysms and high blood pressure. Other habits that may reduce the risk of stroke include:

• Regular exercise.
• A balanced diet with plenty of fruits, vegetables, and whole grains.
• Quitting smoking.
• Keeping a healthy weight.
• Limiting alcohol. This means no more than 2 drinks per day for men and 1 drink per day for women.
• Not using recreational drugs, such as cocaine.