Hemorrhagic Stroke: Understanding the Causes & Care Steps

What is a Hemorrhagic Stroke?

A hemorrhagic stroke is a medical emergency that occurs when a weakened blood vessel in the brain ruptures, causing bleeding (brain haemorrhage) into surrounding tissues. The leaked blood damages surrounding brain tissue and raises pressure inside the skull, disrupting vital brain functions.

According to the National Institutes of Health (NIH), hemorrhagic stroke accounts for about 10%–20% of all strokes in a year globally, with a higher incidence in Asian and low- to middle-income countries. It occurs more often in men and increases with age. The fatality rate ranges from 25% to 48%, depending on the quality of critical care, though effective blood pressure control has been shown to reduce its occurrence.

Types of Hemorrhagic Stroke

Understanding the types of hemorrhagic stroke helps doctors determine the source of bleeding, appropriate treatment, and recovery outlook.

There are two primary types:

• Intracerebral Haemorrhage (ICH): Bleeding within brain tissue, often from hypertension; causes sudden neurological symptoms.
• Subarachnoid Haemorrhage (SAH): Bleeding between the brain and its coverings, usually from an aneurysm; marked by a sudden, severe headache and possible unconsciousness.

Causes of Hemorrhagic Stroke

A hemorrhagic stroke occurs when weakened brain blood vessels rupture, causing bleeding in surrounding tissues.

Several key factors increase this risk:

1. Uncontrolled Hypertension: The main cause of approximately 75% of intracerebral haemorrhage (ICH) cases worldwide.
2. Aneurysm Rupture: Sudden bleeding with severe headache and possible unconsciousness.
3. AVM: Fragile brain vessels rupture, often in younger people.
4. Head Trauma: Injuries or falls trigger brain bleeding.
5. Blood Thinners: Drugs like warfarin increase bleeding risk.
6. Cerebral Amyloid Angiopathy (CAA): In the elderly, amyloid buildup weakens vessels, causing spontaneous bleeds.

Warning Signs and Symptoms of Hemorrhagic Stroke

Recognising stroke symptoms early can save lives. Haemorrhagic strokes develop suddenly, so act fast using the BE FAST rule:

B – Balance: Sudden dizziness or loss of coordination
E – Eyes: Blurred or lost vision
F – Face: Drooping or uneven smile
A – Arms: Weakness or numbness
S – Speech: Slurred or confused speech
T – Time: Call emergency services immediately

Diagnosis of Hemorrhagic Stroke

Prompt diagnosis is vital to prevent brain damage and save lives. Since symptoms resemble those of an ischemic stroke, urgent evaluation helps confirm bleeding and its extent.

1. Neurological Examination: Doctors assess speech, vision, strength, coordination, and reflexes using the NIH Stroke Scale (NIHSS) to measure neurological impairment.
2. Emergency Brain Imaging: A CT scan quickly distinguishes hemorrhagic from ischemic stroke. MRI may follow to identify smaller or deeper bleeds and surrounding tissue damage.
3. Laboratory Tests: Blood tests, such as Complete Blood Count (CBC) Test, DIC (Coagulation) Profile (PT/INR, aPTT), and Electrolytes Test detect clotting issues and imbalances that may worsen brain swelling.

Imaging and Diagnostic Tests for Hemorrhagic Stroke

Imaging confirms a hemorrhagic stroke, locates bleeding, and identifies its cause. These tests guide treatment and improve recovery outcomes.

1. CT (Computed Tomography) Scan: The first-line test in stroke diagnosis, CT scans detect bleeding within minutes, identify the type of stroke, and reveal the clot’s size and location for emergency planning.
2. MRI (Magnetic Resonance Imaging): MRI provides detailed images of brain tissue, detects small or deep bleeds that may be missed on CT, and reveals brain swelling or prior haemorrhages.
3. Cerebral Angiography: Using contrast dye and X-rays, this test visualises brain vessels to detect aneurysms, AVMs, or other vascular abnormalities needing surgical or endovascular repair.
4. CT Angiogram (CTA): A non-invasive test mapping brain arteries with contrast to detect aneurysms, vessel narrowing, or structural defects.
5. Blood Tests: Tests for PT/INR and aPTT, like DIC (Coagulation) Profile, assess clotting function and metabolic balance, ensuring safe treatment and monitoring during recovery.

Treatment Options for Hemorrhagic Stroke

The treatment of hemorrhagic stroke aims to stop active bleeding, reduce pressure on the brain, and prevent further complications. Management depends on the location and severity of the brain haemorrhage, the underlying cause, and the patient’s overall health.

Emergency Medical Management

Immediate treatment is vital to stabilise the patient and prevent further brain injury.

1. Blood Pressure Control: Doctors maintain systolic BP below 140 mmHg using IV drugs like nicardipine or labetalol to limit bleeding.
2. Reversal of Anticoagulation: Patients on blood thinners receive Vitamin K, fresh frozen plasma, or specific antidotes to restore normal clotting.
3. Osmotic Therapy: Mannitol or hypertonic saline lowers intracranial pressure and prevents brain herniation.
4. Mechanical Ventilation: Used in patients with impaired consciousness to maintain the airway and oxygen supply.
5. Seizure Prevention: Antiepileptic drugs help control or prevent seizures linked to cortical bleeding.

Surgical Treatment for Hemorrhagic Stroke

Surgery may be required to remove clots or repair damaged vessels that are causing brain bleeding.

• Craniotomy and Hematoma Evacuation: The skull is opened to remove large hematomas that increase pressure, typically in life-threatening or surgically accessible bleeds.
• Minimally Invasive Stereotactic Aspiration: Uses image guidance and small openings to drain deep haemorrhages while preserving healthy brain tissue.
• Endovascular Coiling or Surgical Clipping: For ruptured aneurysms, coils or clips seal weak vessel walls and prevent re-bleeding.
• AVM Embolisation: A catheter delivers materials to block abnormal AVM blood flow, reducing future haemorrhage risk.

Recovery and Rehabilitation After Hemorrhagic Stroke

Recovery begins once the patient is stable and focuses on regaining function and independence. A team of specialists tailors rehabilitation to the severity of the bleed, the affected brain area, and the overall health.

Rehabilitation usually progresses through three key phases:

1. Acute Phase: Begins in the hospital after stabilisation. Focuses on preventing complications such as bedsores, pneumonia, or stiffness, and initiates gentle movement to maintain circulation and minimise disability.
2. Subacute Phase: Once stable, therapy targets muscle strength, balance, and coordination. Occupational and speech therapy help relearn daily tasks, while counselling supports emotional recovery.
3. Long-Term Phase: Centres on neuroplasticity—helping the brain form new connections through repetitive exercises. Regular follow-ups ensure proper medication, lifestyle changes, and prevention of future strokes.

Hemorrhagic Stroke Recovery Timeline

Recovery varies by the bleed’s size, location, age, and speed of treatment, but most patients progress through these key stages:

1. First 24–72 Hours: Critical Care Phase
   Patients are closely monitored to control bleeding, reduce brain swelling, and stabilise vital signs, preventing re-bleeding or high intracranial pressure.
2. First 2 Weeks: Early Rehabilitation Phase
   Once stable, patients begin assisted movement, physiotherapy, and speech therapy to maintain muscle tone and assess impairments.
3. 1–3 Months: Functional Recovery Phase
   Most recovery in strength, coordination, and speech occurs through structured therapy, supported by emotional and psychological care.
4. 6–12 Months: Long-Term Rehabilitation Phase
   Continued therapy enhances independence and daily function. Ongoing neuroplasticity allows gradual improvement even beyond the first year.

Prevention of Hemorrhagic Stroke

Although age and genetics cannot be changed, most hemorrhagic strokes are preventable through healthy lifestyle choices and appropriate medical care. Prevention also supports overall heart and brain health.

• Maintain Healthy Blood Pressure:
  Hypertension is the main cause. Monitor BP regularly, keep it below 120/80 mmHg, and follow medical advice for control.
• Follow the DASH Diet:
  Eat low-sodium meals rich in fruits, vegetables, whole grains, and lean proteins to reduce blood pressure and strengthen vessels.
• Quit Smoking and Limit Alcohol:
  Tobacco and alcohol weaken blood vessels. Avoid smoking and keep alcohol within safe limits to reduce stroke risk.
• Manage Chronic Conditions:
  Control diabetes, cholesterol, and heart disease through regular checkups and medication to protect vessel health.
• Exercise Regularly:
  Do at least 30 minutes of moderate activity most days. Avoid drug use, as substances like cocaine or amphetamines can trigger brain bleeds.

Hemorrhagic Stroke Survival Rates and Prognosis

Survival largely depends on how quickly treatment begins and the extent of brain injury. Though severe, outcomes have improved with advanced neurocritical care and early rehabilitation.

Recent data show a 30-day mortality rate of around 40%, which improves significantly with rapid emergency care. With timely diagnosis, effective treatment, and ongoing rehabilitation, one-year survival rates can reach about 70%.

Factors Influencing Prognosis

1. Age: Younger patients tend to recover faster due to their greater brain adaptability.
2. Bleed Size and Location: Small, localised bleeds have better outcomes.
3. Treatment Speed: Quick medical response improves survival and recovery.
4. Rehabilitation Access: Early, continuous therapy boosts long-term recovery.

Conclusion

A hemorrhagic stroke is a medical emergency, but timely diagnosis, expert treatment, and structured rehabilitation can significantly improve survival and recovery. Early recognition of symptoms, quick imaging, and advanced care are key to minimising brain damage and restoring function.

At Metropolis Healthcare, we support every step of your health journey with over 4000 tests, including speciality diagnostics for stroke and cardiac health. From comprehensive full-body checkups to home sample collection across 10,000+ touchpoints, we ensure accurate results with a quick turnaround time. You can easily book your tests through our website, app, WhatsApp, or by calling, and trust our network’s precision, convenience, and human care to help you take charge of your health confidently.

FAQs

Can you survive a hemorrhagic stroke?

Yes. With immediate emergency care and proper rehabilitation, many patients survive and regain independence, especially when treatment begins within the first few hours.

What is the life expectancy after a hemorrhagic stroke?

It varies depending on age, overall health, and the severity of the stroke. Early recovery and consistent therapy can improve long-term survival.

How long does hemorrhagic stroke recovery take?

Initial recovery occurs within 3 months, but full rehabilitation may continue for a year or longer, depending on neurological damage.

What causes hemorrhagic stroke?

Uncontrolled hypertension, aneurysm rupture, trauma, and anticoagulant overuse are leading causes.

What’s the difference between hemorrhagic and ischemic stroke?

• Hemorrhagic stroke: Bleeding in or around the brain due to vessel rupture.
• Ischemic stroke: Blockage in an artery restricting blood flow.

Can hemorrhagic stroke be prevented?

Yes. Controlling high blood pressure, eating a heart-healthy diet, and avoiding smoking or heavy alcohol use can drastically lower your risk.

References

1. https://www.ncbi.nlm.nih.gov/books/NBK559173/
2. https://my.clevelandclinic.org/health/diseases/23969-hemorrhagic-stroke
3. https://medlineplus.gov/hemorrhagicstroke.html
4. https://www.medicalnewstoday.com/articles/317111