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Published by Bupa's health information team, March 2009.
This factsheet is for people who have had a haemorrhagic stroke, or who would like more information about it.
A stroke is what happens when the normal flow of blood to your brain is suddenly cut off. A haemorrhagic stroke is caused by a blood vessel bursting, causing bleeding into the brain.
About haemorrhagic stroke
Blood vessels called arteries carry blood to different parts of your body, including your brain. In a haemorrhagic stroke, a blood vessel in your brain bursts, interrupting the normal flow of blood. About one stroke in five happens in this way. The blood vessel that bursts may be:
within the brain - this is called an intracerebral haemorrhage
less commonly, on the surface of the brain, causing bleeding into the area between the brain and the skull called the subarachnoid space - this is called a subarachnoid haemorrhage
Without blood, parts of the brain are starved of oxygen and nutrients. This damages brain cells and they begin to die. Your brain controls everything your body does, including your movement, speech, vision and emotions. So damage to your brain can affect any of these functions.
Symptoms of haemorrhagic stroke
Stroke symptoms usually come on suddenly, within seconds or minutes. If someone has an intracerebral haemorrhage, these may include:
loss of consciousness
numbness, weakness or inability to move the face, arm or leg on one side of the body
sudden loss of sight in one eye or blurred vision
confusion or difficulty understanding
loss of balance or coordination
A good way to recognise if someone has had a stroke is to use the face-arm-speech test (abbreviated to FAST). This involves checking for three of the main symptoms of stroke - facial weakness, arm weakness and speech problems.
If someone has a stroke caused by a subarachnoid haemorrhage, the symptoms may just include the following:
a sudden, severe headache
loss of consciousness
a stiff neck
If someone is displaying any of these symptoms, you should call for emergency help immediately. The sooner a stroke is treated, the better the chance of recovery.
Some strokes may be quite mild and the effects only temporary, while others may be more severe and cause more lasting damage. How much damage a stroke will cause depends on where in the brain the stroke happened and how many brain cells were affected. Common problems after a stroke include:
weakness or paralysis, usually on one side of the body
difficulty swallowing (called dysphagia)
problems with speech, reading and writing
problems with vision - such as double vision, or partial blindness
memory and concentration difficulties
difficulty in controlling your bladder and bowel movements (incontinence)
anxiety and depression
These problems can often improve as you recover.
Causes of haemorrhagic stroke
A haemorrhagic stroke occurs when the flow of blood to your brain is cut off, because of a burst blood vessel. A number of factors can cause a blood vessel in your brain to burst. These may include:
high blood pressure
having an aneurysm (swelling of a blood vessel) in your brain - this may be caused by high blood pressure, or may just be something you're born with
weakening of the blood vessels in your brain, due to build-up of a protein called amyloid in the blood vessel walls
abnormalities in the way in which blood vessels are formed in your brain (this is called arteriovenous malformation)
anything that increases your tendency to bleed, such as receiving treatment with an anticoagulant (eg warfarin) or having a condition such as leukaemia or haemophilia
use of some illegal drugs, such as cocaine
having a head injury
Haemorrhagic strokes are more common in older people. However, subarachnoid haemorrhage is more common in middle-aged people and women are more likely to be affected than men.
Diagnosis of haemorrhagic stroke
If you have symptoms of a stroke, you will usually be taken to your nearest accident and emergency department or directly to a specialist stroke unit, if available in your hospital. Here, doctors will carry out a physical assessment to check whether your symptoms are due to a stroke or something else.
You will have a brain scan as soon as possible after the stroke to work out what type of stroke you have had and which part of your brain is affected. This will usually be a CT scan, but you may also have an MRI scan. You may also need to have blood tests and other scans of your heart and blood vessels.
Treatment of haemorrhagic stroke
You may be treated in a specialist stroke unit or on a general ward while in hospital for stroke. You will be cared for by a team of doctors, nurses and other health professionals.
If you're unable to swallow, you will be given fluid through a drip in your arm and all the nutrients you need though a tube in your nose. You may be given oxygen through a face mask, if you need it, to help you breathe.
You will be helped to sit up and move around as soon as you're able. If you're unable to move, you will be helped to regularly turn in your bed, to reduce your chance of getting pressure ulcers (bed sores) and a blood clot in your leg veins (deep vein thrombosis).
If you were taking an anticoagulant medicine (such as warfarin) before you had your stroke, you may be given a substance called prothrombin complex concentrate via a drip in your arm, together with an injection of vitamin K. This will help your blood to clot and stop the bleeding in your brain.
If you have high blood pressure, you may be prescribed medicine to control this.
If you have had a subarachnoid haemorrhage, you may sometimes be given a medicine called nimodipine, which helps to keep the blood flowing to your brain. You will usually need to take this for about three weeks after your stroke.
Occasionally, surgery to drain the blood from your brain is recommended after a stroke caused by an intracerebral haemorrhage. This is thought to improve recovery in some people. However, this surgery isn't suitable for all people who have had a haemorrhagic stroke. If your doctor or surgeon thinks you could benefit, he or she will explain what will happen in the operation and the risks and benefits of having surgery.
Surgery may also sometimes be carried out if you have had a subarachnoid haemorrhage, caused by an aneurysm. This operation is done to seal off the aneurysm, so that no more blood can escape. It may be done via open surgery, which involves opening up your skull to reach the blood vessel, or via keyhole surgery, where the blood vessel is reached through a small cut in your skin. Again, your doctor or surgeon will advise you if you are suitable for this type of surgery.
Rehabilitation is a crucial part of stroke treatment - it's the process of overcoming or learning to cope with the damage a stroke has caused. After a stroke, you may need to re-learn skills and abilities, learn new skills or adapt to the damage a stroke has caused.
Stroke recovery can be difficult to predict; most people will make most of their recovery in the early weeks and months following the stroke. However, recovery can continue after this time.
The stroke team at the hospital will work out a rehabilitation programme for you (sometimes called a care pathway), designed around your particular needs. This will continue after you leave the hospital. Your rehabilitation programme may involve physiotherapists, speech and language therapists, occupational therapists, ophthalmologists and psychologists, as well as doctors and nurses.
Haemorrhagic stroke Q&As
See our answers to common questions about haemorrhagic stroke, including:
- Subarachnoid haemorrhage. The Stroke Association, October 2006, Factsheet 25. www.stroke.org.uk
- What is a stroke? The Stroke Association. www.stroke.org.uk, accessed 12 November 2008
- Stroke, Hemorrhagic. emedicine. www.emedicine.com, accessed 1 December 2008
- Simon C, Everitt H, and Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005:606-607
- Stroke rehabilitation. The Stroke Association. www.stroke.org.uk, accessed 15 December 2008
- Stroke. GP Notebook. www.gpnotebook.co.uk, accessed 25 November 2008
- When a stroke happens. The Stroke Association. www.stroke.org.uk, accessed 12 November 2008
- National Collaborating Centre for Chronic Conditions. Stroke: national clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: Royal College of Physicians, 2008
- Joint Formulary Committee. British National Formulary. 55th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008:127, 134
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: March 2009