In an ischemic stroke, a blood clot or buildup of fatty tissue blocks or “plugs a blood vessel in the brain. Hemorrhagic stroke occurs when a blood vessel in the brain breaks or ruptures spilling blood into the brain.

Hemorrhagic strokes account for about 15 percent of all strokes, yet responsible for more than 30 percent of all stroke deaths.

Classification of Hemorrhagic Strokes
There are two types of hemorrhagic strokes—intracerebral (ICH) (within the brain’s tissue) and subarachnoid (SAH) (around the brain’s surface and under its protective layer).

While these two types of hemorrhagic strokes are similar, they generally arise from different causes.

Hemorrhagic Stroke Diagnosis
Immediate emergency attention is extremely important following any stroke.  Once a patient arrives at the hospital, doctors are likely to use a computer imaging test such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).  This information helps the doctor choose the best treatment.  If doctors suspect a blood vessel abnormality, they may also perform an angiogram, an x-ray test that provides a picture of the blood vessels in the brain.

Hemorrhagic Stroke Risk Factors

High Blood Pressure
High blood pressure is the most common cause of ICH, responsible for about 60 percent of all cases.  It is the most important controllable stroke risk factor.  Have your blood pressure checked regularly.  If it is consistently more than 140/90 speak with your healthcare provider about treatment options.

Alcohol and Drug Abuse
Excessive alcohol and drug use have been associated with higher incidences of ICH and SAH. About 85 to 90 percent of drug-associated ICH cases occur in people in their 20s or 30s.  If you drink alcohol, do so only in moderation. If you don’t drink, don’t start.

Blood Anti-Clotting Medication
Although anti-clotting medication may prevent ischemic stroke, if your blood becomes “too thin”, you may be at risk for an ICH. Check  with your doctor for guidance about anti-clotting medication.

Blood Clotting Disorders
If you have any type of blood disorder, such as hemophilia or sickle cell anemia, be sure to speak with your healthcare provider. There are ways you can control it to decrease your stroke risk.

Intracerebral Hemorrhage (ICH)
Intracerebral hemorrhage accounts for 10 to 15 percent of all strokes and is the most common type of hemorrhagic stroke. It occurs when a vessel inside the brain ruptures, leaking blood into surrounding brain tissue.

Symptoms of ICH
One feature that nearly all ICH cases share 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 first 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.  Surgery is often performed when the patient has a good chance of recovering and the injured area of the brain is accessible.

Surgery may also be necessary for intracerebral hemorrhages caused by blood vessel problems such as an arteriovenous malformation (AVM).

An AVM is a tangle of thin-walled blood vessels, which can break more easily than normal, healthy vessels.  AVMs are commonly associated with strokes aat younger ages (20-40 years old), but an aneurysm rupture.  That is why doctors can often wait for a patient’s condition to improve before performing surgery, or they may explore less risky and invasive treatment options such as radiation.