Hemorrhagic Stroke: What It Is, Causes, and Symptoms

A brain hemorrhage is not a blockage of a vessel but its rupture, and the mechanism here is the opposite of what you may have expected upon hearing the word "stroke." Cells die not from a lack of blood but from the pressure created by the blood that has spilled inside the skull. Let us break down how this works and by which signs it is recognized.

Hemorrhagic Stroke: What It Is

A stroke is an acute disruption of the brain's blood supply: its cells do not receive oxygen and nutrients and begin to die within several minutes. In the hemorrhagic type, a vessel ruptures, blood spills into the brain tissue or around it, pressure inside the skull rises, and nervous tissue is damaged.

There are two variants. Intracerebral hemorrhage — blood enters directly into the brain tissue; this is the most common type. Subarachnoid — blood ends up between the brain and the thin membranes, often when an aneurysm on the surface of the brain ruptures.

Hemorrhagic strokes account for approximately 20–25% of cases, ischemic strokes for 70–85%, and nontraumatic subarachnoid hemorrhages for about 5%. This type of stroke occurs less often but usually runs a more severe course.

The correct name is "hemorrhagic stroke," that is, a hemorrhage in the brain; sometimes it is mistakenly written as "hemorrhoidal stroke." The first descriptions of such conditions were left by Hippocrates around 467 BC, and Galen later called sudden loss of consciousness "apoplexy" — a blow.

Causes of Hemorrhagic Stroke

The mechanism is one: the vessel wall stops withstanding the blood pressure. Only the reasons why it became weak differ.

• Aneurysm — a bulging of a weakened artery wall that can rupture.
• Arteriovenous malformation — a tangle of abnormally formed vessels that can rupture inside the brain.
• High blood pressure — over time weakens vessel walls and increases the risk of rupture.
• Head trauma — damage to the brain can cause bleeding.

Symptoms of Hemorrhagic Stroke

The signs appear suddenly, most often within minutes: numbness or weakness of the face, arm, or leg, especially on one side; confusion, difficulty speaking or understanding; vision disturbance in one or both eyes; difficulty walking, dizziness, loss of balance; sudden severe headache without a known cause.

The F.A.S.T. test helps remember the main points: they check whether the corner of the mouth droops when smiling, whether one arm weakens when both are raised, and whether speech has become slurred. The last letter stands for time — you need to call immediately.

Call 103 or 112 immediately: the corner of the mouth has suddenly drooped, one arm has weakened and "drifts" downward, speech has become slurred or strange, confusion has appeared, vision loss, unsteadiness when walking, or a very severe headache without cause.

How It Differs from Ischemic Stroke

In ischemic stroke, an artery narrows or becomes blocked, and an area of the brain is left without blood; in hemorrhagic stroke, a vessel bursts and blood enters the brain. The ratio of ischemic to hemorrhagic cases is on average 4:1–5:1.

Ischemic stroke more often occurs in people over 60 years of age with a history of myocardial infarction, rheumatic heart disease, rhythm disorders, and diabetes mellitus, often at night and without loss of consciousness. Hemorrhagic stroke occurs less often but is usually more severe.

Diagnosis and Risks of Complications

The doctor examines the person, asks about symptoms and past illnesses, and orders imaging studies — these are what show whether there is blood in the brain. The doctor's first step is to find the cause of the bleeding in the brain; after a stroke, rehabilitation helps restore lost skills.

Blood raises pressure inside the skull and damages brain tissue, and cells die already in the first minutes, so the consequences are often persistent: 70–80% of survivors become disabled, and approximately 20–30% of them require constant care. 95% of strokes occur at age 45 and older, two thirds after 65.

This text is for reference: it explains the mechanism and signs but does not replace consultation with a doctor, who makes decisions about a specific person.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer