An Overview of Hemorrhagic Strokes

Long-term hypertension (high blood pressure) is a known risk factor for ischemic strokes, which are strokes caused by interruption of blood supply in the brain. Extremely high blood pressure, even for a short period of time, can cause hemorrhagic strokes, which are strokes caused by bleeding in the brain.

A doctor taking a patient's blood pressure
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Causes of Hemorrhagic Strokes

Most strokes occur due to a blockage of blood flow to a part of the brain, but approximately 13% of strokes occur due to bleeding in the brain. Of all the causes of hemorrhagic stroke, high blood pressure is the most common, accounting for approximately 80% of all cases.

Other causes include aneurysms and other abnormal blood vessels, trauma, and bleeding disorders. The damage caused by an ischemic stroke can also trigger a hemorrhagic stroke.

High Blood Pressure as a Risk Factor for Stroke

High blood pressure can significantly increase the risk of a hemorrhagic stroke. This risk is even more pronounced in the elderly, people who smoke, men, those with diabetes, and people who drink alcohol.

High blood pressure can lead to intracerebral hemorrhage (ICH), which is bleeding within the skull, by damaging the fragile walls of small arteries inside the deeper areas of the brain. These are the same arteries affected by lacunar strokes, which are so common in white matter areas. The areas most commonly damaged by ICH are the brainstem, the internal capsule, and the cerebellum.

In some cases, the bleeding caused by high blood pressure may be large enough that blood spills into the brain's ventricles, causing an intraventricular hemorrhage, a condition that can result in life-threatening hydrocephalus.

Symptoms

The symptoms of ICH caused by high blood pressure vary depending on the location and size of the bleeding and are often similar to the symptoms of an ischemic stroke. Symptoms of hemorrhagic stroke consist of:

  • Weakness of the face, arm, and/or leg on one side of the body
  • Numbness in the face, arm, and/or leg on one side of the body
  • Inability to understand spoken language or inability to speak
  • Inability or difficulty writing or reading
  • Vertigo and/or gait imbalance
  • Nausea or vomiting
  • Severe headache or double vision

In general, a hemorrhagic stroke is often associated with severe head pain and dizziness, but in some instances, a hemorrhagic stroke may not cause these symptoms.

In rare cases, the bleeding caused by high blood pressure is so profuse that it leads to a rapid increase in intracranial pressure, which causes more serious consequences, such as unresponsiveness, inability to move, or coma.

If you or a loved one are showing any symptoms of a stroke, call 911 for help immediately. Strokes must be treated immediately. The longer you wait, the more brain damage will result.

Diagnosis

An imaging test to identify bleeding in the brain is the most reliable way to diagnose a hemorrhagic stroke. The first test performed usually is a head CT, which is a rapid and reliable way to rule out bleeding in the brain.

When bleeding is found, but the source of the bleeding is not clear, other tests such as a cerebral angiogram or an MRI of the brain with contrast may be necessary. These tests help to diagnose other causes of bleeding, such as an arteriovenous malformation, aneurysm, amyloid angiopathy, or brain tumor.

Treatment

The treatment of bleeding in the brain caused by high blood pressure starts with stabilization and diagnosis. This is because an enlarging bleed in the brain can progress rapidly and may produce severe consequences.

Usually, blood pressure is controlled in order to prevent further bleeding. Other possible interventions depend on factors such as the size of the bleeding, the severity of the symptoms, and whether the interventions being considered can be expected to make a difference in the overall outcome.

In some cases, the bleeding must be surgically evacuated immediately, because it can produce pressure on the brain. In other cases, the risks of surgery clearly outweigh the potential benefits, leading doctors and families to refrain from further treatment.

In the most severe cases, bleeding has caused so much damage to the brain that surgical intervention is futile, and brain death may result with or without intervention.

A Word From Verywell

Moderately high blood pressure can slowly increase the risk of stroke. This is why it is important to maintain a blood pressure that follows recommended guidelines.

Extremely high blood pressure, however, can lead to more serious strokes. The most common causes of extremely high blood pressure include untreated hypertension, severe illness, and drug use.

Taking care of your health can go a long way in preventing serious medical emergencies such as hemorrhagic stroke.

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Article Sources
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  1. American Stroke Association. Hemorrhagic stroke (bleeds).

  2. An SJ, Kim TJ, Yoon BW. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: An update. J Stroke. 2017;19(1):3-10. doi:10.5853/jos.2016.00864

  3. Harvard Medical School. Hemorrhagic stroke. February 2019

  4. New York-Presbyterian Hospital/Weill Cornell Medical Center. Intracerebral hemorrhage. Updated October 2017

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