Hemorrhagic Strokes

Hemorrhagic Strokes

There are two main types of hemorrhagic strokes… Intracerebral hemorrhage(bleeding within the brain) and subarachnoid hemorrhage (bleeding between the inner and outer layers of the tissue covering the brain. Other disorders that involve bleeding inside the skull include epidural or subdural hematoma, which are usually caused by a head injury. These disorders cause different symptoms and are not considered stroke.

Intracerebral hemorrhage accounts for 10-15% of all strokes and has higher mortality rates than cerebral infarctions (ischemic strokes)

Patients with hemorrhagic stroke present with similar focal neurological deficits but tend sicker than patients with ischemic stroke. Patients with intracerebral bleeds are more likely to have headache, altered mental status, seizures, nausea and vomiting, and/or marked hypertension; however, none of these findings reliably distinguishes between hemorrhagic stroke and ischemic stroke.

Intracerebral hemorrhage most often results when chronic high blood pressure weakens a small artery, causing it to burst. Using cocaine or amphetamines can cause temporary but very high blood pressure and hemorrhage.

In some older people, an abnormal protein called amyloid accumulates in arteries of the brain. This accumulation weakens the arteries and can cause hemorrhage.

Intracerebral hemorrhage accounts for about 10% of all strokes but for a greater percentage of deaths due to stroke. Among people older than 60, intracerebral hemorrhage is more common than subarachnoid hemorrhage.

Less common causes include blood vessel abnormalities present at birth, injuries, tumors, inflammation of blood vessels (vasculitis), bleeding disorders, and anticoagulants in doses that are too high. Bleeding disorders and anticoagulants increase the risk of dying from an intracerebral hemorrhage.

An intracerebral hemorrhage begins abruptly. In about half of the people, it begins with a severe headache, often during activity. However, in older people, the headache may be mild or absent. Symptoms suggesting brain dysfunction develop and steadily worsen as the hemorrhage expands.

Some symptoms, such as weakness, paralysis, loss of sensation, and numbness, often affect only one side of the body. People may be unable to speak or become confused. Impaired or lost vision is possible. The eyes may point in different directions or become paralyzed. The pupils may become abnormally large or small. Nausea, vomiting, seizures, and loss of consciousness are common and may occur within seconds to minutes.

Doctors can often diagnose intracerebral hemorrhages on the basis of symptoms and results of a physical examination. However, computed tomography (CT) or magnetic resonance imaging (MRI) is also done. Both tests can help doctors distinguish a hemorrhagic stroke from an ischemic stroke. The tests can also show how much damage the brain tissue incurred and whether there is increased pressure in other areas of the brain. A test of the blood sugar level must be done because a low blood sugar level can cause symptoms similar to those of stroke.

Intracerebral hemorrhage is more likely to be fatal than ischemic stroke. The hemorrhage is usually large and catastrophic, especially in people who have chronic high blood pressure. More than half of the people who have a large hemorrhage die within a few days. Those who survive usually recover consciousness and some brain function over time. However, most do not recover all lost brain function.