What is a hemorrhagic stroke?

A hemorrhagic stroke, also known as a cerebral hemorrhage, is a serious medical emergency that happens when a weakened blood vessel in or around the brain bursts, causing bleeding. This bleeding can damage brain cells, block blood flow to other parts of the brain and create dangerous pressure inside the skull. 

There are two main types of hemorrhagic strokes: intracerebral hemorrhage, which occurs when bleeding happens directly in the brain, and subarachnoid hemorrhage, which happens in the space between the brain and its protective layers.

Although less common than ischemic strokes, which occur when a blood clot blocks blood flow to the brain, hemorrhagic strokes make up about 10 to 15% of all strokes. Both types require immediate medical attention to prevent serious complications.

Hemorrhagic stroke symptoms

The symptoms of a hemorrhagic stroke can vary, depending on where the bleeding happens and how severe it is. Common signs to look out for include:

  • A sudden, severe headache
  • Confusion or trouble thinking clearly
  • Weakness or numbness on one side of the body
  • Difficulty speaking or understanding speech
  • Vision problems
  • Dizziness or trouble balancing
  • Nausea or vomiting
  • Seizures
  • Losing consciousness

Other possible symptoms include:

  • Stiff neck
  • Sensitivity to light
  • Drooping eyelids
  • Trouble swallowing
  • Changes in behavior or personality

Since these symptoms can also be caused by other health issues, it's important to see a doctor right away if you notice any of them. Getting treatment quickly can make a big difference in your recovery.

When to see a doctor

All strokes are medical emergencies that should be treated at the emergency department. Calling 911 allows you or your loved one to get immediate care on the way to the hospital.

Call 911 if you see someone showing possible signs of hemorrhagic stroke. A good way to remember them is the acronym BE FAST:

  • B—Balance: Check for a loss of balance or coordination.
  • E—Eyes: Watch for vision changes, like loss of vision or double vision.
  • F—Face: Look to see if one side of the mouth droops when smiling.
  • A—Arms: Check if one arm drifts downward or feels weak.
  • S—Speech: Listen for slurred speech or unusual speech patterns.
  • T—Time: It is time to call 911 if you notice any of these symptoms.

If you experience these symptoms, do not drive to the emergency department or ask anyone else to drive you. Instead, always call 911.

patient consulting with doctor

Hemorrhagic stroke causes

High blood pressure is the most common cause of hemorrhagic strokes. Having high blood pressure over a long period can weaken blood vessels. Sometimes, these weakened blood vessels stretch, creating a balloon or bulge called an aneurysm. The walls of an aneurysm are thin, making them more likely to break open.

Another possible cause of a hemorrhagic stroke is an arteriovenous malformation (AVM). In an AVM, problems with the arteries cause poor blood flow in the brain. Arteries and veins in an AVM are also thin and can bulge and break open easily, causing a hemorrhagic stroke.

Hemorrhagic stroke risk factors

Anyone can experience a hemorrhagic stroke, but certain factors can increase your risk. While you can’t control every risk factor, you can take practical steps to protect yourself from a hemorrhagic stroke.

The most common risk factor of hemorrhagic stroke is high blood pressure. Keeping your blood pressure within a healthy range is especially important, since it puts the most strain on blood vessels in the brain. Making healthy lifestyle adjustments, such as quitting smoking, moderating alcohol use, eating nutrient-rich foods and staying active, helps strengthen your overall health.

If you’re living with a chronic condition or if you or a family member has a history of conditions such as autosomal dominant polycystic kidney disease or an aneurysmal subarachnoid hemorrhage, it’s important to work with your care team for treatments that can further lower your risk.

Risk factors for hemorrhagic stroke include:

  • Age (55 or older): The risk of stroke increases with age, and if you have an ongoing health condition like high blood pressure, your risk is even higher.
  • Sex: Men are more likely than women to have lifestyle habits, like smoking, that can increase blood pressure and stroke risk.
  • Brain tumors: Certain types of brain tumors can change the brain or raise pressure, which can increase stroke risk.
  • Alcohol use: Drinking too much alcohol can damage your liver, raise your blood pressure, and contribute to other health issues linked to stroke.
  • Smoking: Smoking can raise blood pressure, harm blood vessels and affect how blood clots form, increasing stroke risk.
  • Medications: Certain medications, such as blood thinners, may increase risk. So always discuss with your doctor about the right medications for your specific risk.
  • Illegal or recreational drug use: Drugs can raise heart rate and blood pressure, which can cause long-term damage.
  • Certain medical conditions: Conditions like kidney disease, liver disease and sickle cell anemia can also increase the risk of hemorrhagic stroke.

Being aware of these risk factors and managing them can help lower your chances of having a hemorrhagic stroke.

Want to learn about your risk for hemorrhagic and other types of stroke?
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Complications of hemorrhagic stroke

Hemorrhagic stroke complications can vary from person to person. The types of complications you have depend on the part of the brain affected and how severe the stroke was. Sometimes, complications resolve quickly. In other cases, complications cause lifelong damage.

Receiving treatment as soon as possible and actively participating in stroke rehabilitation can improve your daily functioning, reduce disability and help you become more independent after a stroke.

Possible complications of a hemorrhagic stroke include:

  • Difficulty understanding speech
  • Impaired balance or coordination
  • Issues with speaking or swallowing
  • Stiff or tight muscles on one side of the body
  • Vision changes, such as double vision or loss of vision
  • Weakness on one side of the body
  • Seizures
  • Cognitive or behavioral changes
  • Depression

How is a hemorrhagic stroke diagnosed?

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If you or someone you know is experiencing the symptoms of a stroke, call 911 immediately. To determine the type of stroke, doctors will ask about the person’s medical history, conduct a physical exam and order diagnostic tests. They work quickly to make a clear diagnosis so treatment can start as soon as possible.

Medical history and exam

A hemorrhagic stroke can make someone feel very sleepy, confused or even unconscious, so family members or loved ones may need to provide important details about the patient’s medical history. An emergency medical technician, doctor, nurse or another medical professional will want to know if the person has high blood pressure, a bleeding disorder or if they take blood thinners. They might also ask about habits like smoking, drinking alcohol or using illegal drugs, since these can raise the risk of a stroke.

During the physical exam, your care team will check for signs of a hemorrhagic stroke, like changes in how the person thinks or speaks, problems with eye movements, weakness on one side of the body, drooping on one side of the face, or difficulty moving the neck. These signs help your care team figure out what’s happening and start the right treatment quickly.

Blood tests

While there isn't one blood test that can directly diagnose a hemorrhagic stroke, blood tests can help your care team understand what might be causing the symptoms. Some tests that may be done include:

  • Complete blood count (CBC): This test checks the overall health of your blood and can help identify problems like clotting issues, anemia or infections.
  • Coagulation tests: These measure how quickly your blood clots, which is important for understanding your stroke risk.
  • Electrolyte tests: These check the balance of certain substances in your blood, which help your muscles and nerves work properly.
  • Blood glucose test: This measures your blood sugar levels to see if they’re too high or low, as this can affect stroke risk.
  • C-reactive protein tests: These check for inflammation in the body, which may be caused by damage to the arteries.
  • Liver and kidney function tests: These help rule out other health issues or find any irregularities that could be linked to a stroke.

These tests, along with other exams, give doctors the information they need to figure out the cause of the stroke and start the right treatment.

Imaging tests

To diagnose a stroke or rule out other conditions that may have similar symptoms, your care team will likely order one or more imaging tests. These tests help doctors see what’s happening inside the brain and guide the next steps in treatment. Some common imaging tests include:

  • Computed tomography (CT) scan: A CT scan creates images that show bleeding in the brain. It helps doctors distinguish between a hemorrhagic stroke (caused by bleeding) and an ischemic stroke (caused by a blockage).
  • Magnetic resonance imaging (MRI): An MRI uses magnets to take detailed images of the brain. It can help doctors understand the stage and potentially the underlying cause of a hemorrhagic stroke, including how much damage has occurred and where.
  • CT angiography: This test takes detailed images of the blood vessels to identify potential problems, such as an aneurysm or arteriovenous malformation (AVM), which may be causing the hemorrhagic stroke.
  • Spinal tap (lumbar puncture): If a CT scan is unclear or unable to detect certain issues, a spinal tap can be used to check for subarachnoid hemorrhage, especially if there is still concern about a hemorrhagic stroke despite negative results from other tests.

These imaging tests give your care team a clearer picture of what’s happening in your brain and help them make quick, informed decisions about the best treatment for you.

Hemorrhagic stroke treatment

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If you or someone else shows signs of a hemorrhagic stroke, it’s important to seek emergency medical help right away. Getting quick treatment can prevent serious complications and limit damage to the brain.

The goal of treatment is to stop life-threatening problems right after the stroke, reduce the risk of another stroke, and help the person recover as much normal function as possible. It also focuses on preventing long-term issues and improving quality of life through rehabilitation.

The sooner treatment begins, the better the chances for recovery.

Medication

If you are having a hemorrhagic stroke, your doctor may give you medication to help:

  • Lower blood pressure
  • Prevent seizures
  • Reduce pressure in the brain and skull
  • Slow or stop bleeding

After a stroke, medication can help you manage chronic conditions, which can lower your risk of having another stroke or treat other side effects of a stroke. These medications might include prescriptions to manage:

  • An irregular heart rate or rhythm
  • Blood pressure
  • Depression
  • Diabetes
  • Unhealthy cholesterol levels

Surgery

In some cases, surgery may be needed to stop the bleeding, reduce pressure on the brain, and improve recovery. The types of surgeries that may be performed include:

  • Surgery to repair an : Surgeons may use a stent, coil or clip to seal off the aneurysm, stop the bleeding, and strengthen the blood vessel wall to prevent it from bleeding again.
  • Surgery to remove an arteriovenous malformation (AVM): If the AVM is in a place that’s easy to reach, doctors may remove it to stop the bleeding and lower the risk of future strokes.
  • Stereotactic radiosurgery: If the AVM is in a hard-to-reach spot, doctors may use special high-energy beams to target the area. This helps create scar tissue that stops the bleeding and strengthens the blood vessels.
  • Surgery to remove the hemorrhage or part of the skull: If there is a lot of pressure in the brain from bleeding, doctors may need to remove the blood or part of the skull to relieve it.

The type of surgery you may need depends on where the problem is and how severe it is. These surgeries can make a big difference in your recovery and help prevent further complications.

Rehabilitation

Rehabilitation is often an essential part of the healing process after a hemorrhagic stroke. Participating in rehabilitation therapy can help you improve daily function, increase independence and relearn skills affected by the stroke.

Rehab services typically begin in the hospital and continue for several months or years in a short-term rehab facility, an outpatient clinic or your home. You may need a combination of therapies to help with your recovery:

  • Speech therapy: This can help you regain or improve your ability to speak, understand language, and control the muscles used for talking, breathing, eating and swallowing.
  • Physical therapy: Aimed at strengthening your muscles, improving balance and helping you regain the use of your arms and legs.
  • Occupational therapy: This helps you safely perform daily tasks, especially activities that require fine motor skills, such as dressing, cooking or other chores.
  • Cognitive therapy: Focuses on improving memory, concentration and other mental abilities that may have been affected.

These therapies work together to support your recovery and help you regain as much independence and function as possible.

Find a location near you

If you or someone you know has symptoms of a hemorrhagic stroke, get help right away. Our North and Central Texas hospitals have stroke care teams ready to quickly assess and treat hemorrhagic strokes. Find a nearby location to get the care you need and reduce the risk of a full stroke.

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Frequently asked questions

  • Is a cerebral hemorrhage a stroke?

    Yes, a cerebral hemorrhage is a type of stroke called a hemorrhagic stroke. It happens when a blood vessel in the brain bursts, causing bleeding that damages brain tissue. Since it affects blood flow and brain function, a brain bleed is considered a stroke and needs emergency medical care.

  • What is the most common cause of a hemorrhagic stroke?

    The most common cause of a hemorrhagic stroke is high blood pressure. Over time, it weakens blood vessels in the brain, making them more likely to burst and bleed. Managing blood pressure through a healthy lifestyle and medication can help lower the risk of this type of stroke.

  • Are hemorrhagic strokes hereditary?

    Yes, hemorrhagic strokes can be hereditary, especially if there's a history of aneurysms, AVMs or high blood pressure. However, lifestyle choices like smoking, heavy drinking and poor diet also increase risk. If strokes run in your family, talk to your doctor about ways to stay healthy.

  • Can a fall cause a hemorrhagic stroke?

    Yes, a fall can cause a hemorrhagic stroke if it leads to a head injury. A hard hit to the head can damage blood vessels, causing bleeding in the brain. If someone falls and has a severe headache, confusion or weakness, get medical help right away.

  • Can a person recover from a hemorrhagic stroke?

    Yes, recovery from a hemorrhagic stroke is possible, but it takes time. Quick treatment and rehab are key. Many people need speech, physical, occupational or cognitive therapy to regain skills. While some recover fully, others may have lasting challenges, but rehab can help improve independence and quality of life.

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