The brain is a delicate organ with numerous blood vessels. These blood vessels are extremely important as they nourish the brain and provide it with the oxygen it needs on a daily basis. Without these arteries, life would be impossible. These cerebral arteries are prone to health complications, in particular, bleeding or rupture. When this occurs, a hemorrhagic stroke can result. Hemorrhagic strokes are the less common type of stroke, the more common being ischemic strokes. Hemorrhagic strokes are often extremely severe and in many cases, fatal. There are two different types of hemorrhagic stroke: intracerebral and subarachnoid. They are named according to the location of occurrence in the brain. In respect to an intracerebral stroke, the bleeding is within the brain, while in terms of a subarachnoid stroke, the bleeding results in the subarachnoid space. The subarachnoid space is located between the brain and the meninges, which are a protective outer coating to the brain. The two most common causes of hemorrhagic strokes are aneurysms and arteriovenous malformations. Aneurysms occur when a weakened blood vessel begins to expand. This weakens the blood vessel and directly promotes its rupture and subsequent bleeding in the tissues around the vessel. Arteriovenous malformation is a termed used to describe a group of abnormal blood vessels. These blood vessels are improper and more prone to rupture or bleeding than normal blood vessel formations or groupings.

The management of hemorrhagic stroke is extremely difficult as the symptoms are often severe and life threatening. These symptoms can differ between the two subtypes of hemorrhagic stroke as well. In general, they include severe headaches, fainting or loss of consciousness, seizures, cognitive decline, and vomiting. The management of hemorrhagic stroke includes seeking treatment immediately following the onset of symptoms. Prognosis of hemorrhagic strokes is extremely poor, and only declines if treatment is not sought immediately. If symptoms are present, physicians will elect to confirm brain bleeding with the use of various tests and diagnostic procedures. These can include cerebral computed tomography (CT) scans, magnetic resonance imaging (MRIs) and cerebral angiography. Cerebral CT scans and MRI’s are the most common tests used today in the management of hemorrhagic strokes. If bleeding is confirmed with the use of these procedures, treatment will begin immediately. Patients often are directly transported to the intensive care unit of the hospital due to the severity of brain bleeding. Common treatment methods include medications and surgery. It is also imperative to monitor the patients breathing as bleeding can disrupt autonomic functioning in the brain. Medications often used help to control blood pressure and relieve cerebrum swelling. Also, physicians may elect to use medications to help control headaches and seizures. Hemorrhagic stroke surgery may be needed if the situation is life threatening. The management of hemorrhagic stroke differs in accordance to what is causing the present stroke, an aneurysm or arteriovenous malformation. Also, decompressive craniotomy may used as well to relieve intracranial pressure from brain bleeding. The bleeding stroke survival rate is low. If treatment is sought immediately, patients may survive from a hemorrhagic stroke. Recovery from hemorrhagic stroke often involves the use of various therapists to help regain every life functioning.

Intracerebral Hemorrhage

Intracerebral hemorrhaging results when a weakened blood vessel bursts inside the brain. Blood can then leak out into the surrounding tissues of the brain, which severely damages tissue, often permanently. Intracranial pressure can become so severe that fainting or death can result if it is not relieved as soon as possible. High blood pressure is often behind intracerebral hemorrhaging as it weakens blood vessels without it being known. It is important to consistently monitor blood pressure to avoid the developing of an intracerebral hemorrhage.

Subarachnoid Hemorrhage

Subarachnoid hemorrhaging occurs when blood vessels located outside of the brain ruptures and bleeds into the subarachnoid space. The subarachnoid space is located between the meninges, which provide a protective covering to the brain and the brain itself. This space can rapidly fill with blood and cause severe pain and migraines. This pressure can also result in fainting and even death.

The management of hemorrhagic strokes involves quickly stopping brain bleeding and reliving pressure inside the skull.

Hemorrhagic Stroke Symptoms

14Hemorrhagic stroke symptoms often occur rapidly and increase in intensity over time. It is important to monitor for these symptoms, as the prognosis of hemorrhagic stroke is poor, especially if treatment is not sought immediately. Symptoms often vary between both intracerebral and subarachnoid hemorrhages.

Intracerebral Symptoms

In this type of hemorrhagic stroke, symptoms include muscle weakness or numbness, speech difficulties, vision impairments, vomiting, trouble with motor movements, and comas.

Subarachnoid Symptoms

In this type of hemorrhagic stroke, symptoms include a severe headache that begins immediately and worsens, fainting or loss of consciousness, vomiting, muscle stiffness in the neck, and trouble with bright lights.

The management of hemorrhagic stroke involves being constantly aware for these signs and symptoms. Prognosis of hemorrhagic stroke can be improved if treatment begins immediately following onset.

Hemorrhagic Stroke Diagnosis

To begin the management of hemorrhagic strokes, various diagnostic tests and procedures are used to confirm the presence of bleeding in the brain. These tests and procedures are imperative to the bleeding stroke survival rate as early detection may be life saving. Common tests include cerebral computed tomography (CT) scans, magnetic resonance imaging, and cerebral angiography.

Cerebral Computed Tomography (CT) Scans

Cerebral CT scans are the most common test used in the management of hemorrhagic strokes. CT scans are also non-invasive and pose no risk to the patient. They provide detailed images of the brain and can detect the presence of brain bleeding. CT scans are the gold standard for diagnosing brain hemorrhages.

Magnetic Resonance Imaging (MRI)

MRI’s are also a non-invasive test that can provide highly detailed images of the cerebrum. They are often used it CT scans come back negative for bleeding as they can provide more detail than a CT scan.

Cerebral Angiography

Cerebral angiograms are invasive procedure and thus, rarely used in the management of hemorrhagic strokes. They elicit results that can show physicians how blood is flowing to and from the brain.

Treatment of Hemorrhagic Strokes

subarachnoid_hemorrhage_surgical_clip_700wThe management of hemorrhagic strokes must begin immediately to avoid problematic and irreversible health complications in the future. Also, early treatment is imperative to improve prognosis of hemorrhagic strokes. The management of hemorrhagic strokes includes lifestyle changes, medications and hemorrhagic stroke surgery.

Lifestyle Changes

The most important thing, if one survives from a hemorrhagic stroke, is to lower blood pressure. Hypertension can directly weaken blood vessels and make them more prone to rupturing and thus, aneurysm. Exercising and eating healthy is imperative to strengthening heart muscles and lowering blood pressure.


  • Medications are almost always used in the management of hemorrhagic stroke. The most common medications are mannitol, antihypertensive and anticonvulsants.
  • Mannitol is a sugar that is imperative in decreases intracranial pressure and blood in the brain. It works by altering the osmotic gradient to encourage fluids to leave the skull.
  • Antihypertensives are imperative in the management of hemorrhagic strokes. They decrease blood pressure and prevent weakening of the cerebral arteries in the brain.
  • Anticonvulsants are another common medication in the management of hemorrhagic strokes. This class of medications deters the occurrence of seizures in patients suffering from a hemorrhagic stroke.

Hemorrhagic Stroke Surgery

Surgery is common in the management of hemorrhagic strokes. This is due to the severity of brain bleeding and the permanent damages it may cause. The type of hemorrhagic stroke surgery depends on the cause of brain bleeding. In the case of aneurysms, a clamp may be surgically inserted on the ruptured artery to prevent blood from spilling out onto the surrounding brain tissues causing damage. In terms of ateriovenous malformations, neurosurgeons may be able to remove the group of abnormally formed vessels or repair them to cease bleeding into the brain and surrounding areas. Another common hemorrhagic stroke surgery is decompressive craniotomy. Decompressive craniotomy involves the surgical drilling of a small hole into the skull to decrease intracranial pressure and avoid death. Surgery is used as a life saving tool and only done as a last resort in the management of hemorrhagic stroke.

Prognosis of Hemorrhagic Stroke

Hemorrhagic strokes are extremely severe and associated with a poor prognosis and recovery. This is due to the permanent damage they impose on the brain. When blood pools out and comes in contact with the surrounding tissue, death of the tissue can result. This is permanent damage and depending where it occurs in the brain, it can be fatal. If patients do survive, recovery form hemorrhagic stroke involves the use of physical, occupational and speech therapists. This is to help patients return to a normal lifestyle and help prevent injury around the home. Also, speech therapists encourage and promote speech development if damage is done to the language areas of the brain.

Hemorrhagic strokes are one of the most dangerous and life threatening brain complications today. It is important to be alert for the signs and symptoms of a hemorrhagic stroke as treatment must begin immediately to better prognosis and recovery.