Hemorrhagic Stroke

Haemorrhagic stroke happens when a blood vessel in the brain leaks or bursts, causing bleeding into brain tissue (intracerebral haemorrhage) or the space around the brain (subarachnoid haemorrhage). It's less common than ischaemic stroke (about 15-20% of strokes) but more often fatal or disabling. It's a medical emergency — dial 112.

Recognise stroke — use FAST

Signs are similar to ischaemic stroke:

• Face drooping on one side
• Arm weakness on one side
• Speech slurred or strange
• Time to call for help — dial 112
• In haemorrhagic stroke specifically, an extremely sudden severe headache ("worst headache of my life") is common, especially in subarachnoid haemorrhage
• Neck stiffness
• Vomiting
• Rapid loss of consciousness

Causes

• High blood pressure — by far the most common cause; often uncontrolled for years
• Brain aneurysm rupture — a weak bulge in an artery wall
• Arteriovenous malformations (AVMs) — abnormal tangle of vessels
• Blood thinners — when bleeding occurs, it tends to be severe
• Head injury
• Bleeding disorders
• Cerebral amyloid angiopathy — common cause of lobar haemorrhage in older adults
• Cocaine, methamphetamine, and some recreational drug use
• Cavernomas, brain tumours with bleeding

Diagnosis and treatment

• CT scan — confirms bleeding and its location, done on hospital arrival
• Additional imaging — CT angiography, MRI, cerebral angiogram to find the bleeding source
• Blood-pressure control — urgent, carefully titrated
• Reverse blood-thinner effects if the person was on anticoagulants
• Surgery — for some cases: removing the blood clot, clipping an aneurysm, or endovascular coiling (a catheter-based procedure). Highly specialised care, available at neurosurgical centres across India.
• Monitor in ICU — for swelling, repeat bleeding, seizures, complications
• Rehabilitation — as for ischaemic stroke, usually more prolonged given greater initial damage in many cases

Prevention

• Control blood pressure — the single most important thing. Most haemorrhagic strokes are preventable with good BP control.
• Don't smoke or chew tobacco
• Limit alcohol
• Be cautious with blood thinners — take exactly as prescribed; monitoring where required
• Treat any known aneurysm or AVM on specialist advice
• Avoid recreational stimulants
• Manage diabetes and cholesterol — contribute to overall vessel health
• Report and investigate new severe headaches, especially if not typical for you