A haemorrhagic stroke occurs in 20% of all cases, and is caused by a blood vessel bursting which bleeds into and around the brain. It can also be caused by the expansion of a blood vessel, known as a brain aneurysm. This guide to Haemorrhagic stroke includes symptoms to look out for, tests for a diagnosis and likely treatments.
The main cause of a haemorrhagic stroke is high blood pressure which can weaken the arteries in the brain making them more likely to burst or rupture.
High blood pressure is caused by a number of factors including stress, lack of exercise, excess weight, smoking and excess alcohol.
The symptoms of a haemorrhagic stroke are the same as those for other types of stroke. If you or someone you know are experiencing symptoms, dial 999 for an ambulance, as the sooner a diagnosis is made and treatment started, the less damage may occur.
What are the symptoms/signs of a Haemorrhagic Stroke?
What are the symptoms/signs of a haemorrhagic stroke? If you are in doubt, the key signs of a stroke are:
F Face: numbness in the face (one side may drop, one eye or one side of the mouth)
A Arms: ability to raise both arms above the head
S Speech: maybe confused or garbled
T Time: to call 999
There are other signs, possibly less obvious, which include:
- Difficulty swallowing (dysphagia)
- Sudden loss or blurring vision
- Being or feeling sick
- Complete paralysis of 1 side of the body
- Difficulty understanding what others are saying
- Problems with balance and co-ordination
- Sudden and severe headache/blinding pain
- Loss of consciousness
These are not confined to symptoms of a stroke, but please dial 999 if you are concerned. The sooner you act, the sooner a diagnosis can be made.
Diagnosis of a haemorrhagic stroke
Undergoing tests as soon as possible on arrival in hospital will help determine whether or not it is a haemorrhagic stroke, which will determine what treatments need to be started. There are both physical tests and scans that may be done.
The NHS has specialist stroke units and services to help with faster diagnosis and rehabilitation and care. A specialist stroke care unit is where a patient will be taken who has been admitted as an emergency following a stroke or a suspected stroke. There may be two sides to such a unit – the Acute Stroke care ward, and a Stroke Rehabilitation Ward.
Tests to confirm diagnosis of a haemorrhagic stroke
Tests to confirm that a haemorrhagic stroke has occurred will benefit those who can be prescribed medication to quickly clear blood clots or anti-coagulent treatment to stop future blood clotting.
Tests are also important for those who may be unable to communicate as a result of the stroke, or those who already taking blood thinners or anti- coagulents such as warfarin. (It is a good idea to keep an updated list of medication, particularly if blood thinners are being taken, just in case an emergency admission to hospital happens).
The initial physical tests for a stroke will include:
Blood pressure – a standard test to check the levels of blood pressure
Blood test – to check cholesterol levels and blood sugar levels
Pulse check – to check for irregular heartbeat (arrythmia is a cause of x stroke)
Swallow test – because the ability to swallow is often affected after having a stroke this test may be undertaken. If they have problems such as choking or coughing or other difficulties swallowing, they will be referred to a speech and language therapist for a detailed assessment.
Scans to test for a Haemorrhagic Stroke
Even if the physical symptoms are obvious, within an hour of arrival in hospital a brain scan, CT or MRI should also be carried out to help determine or confirm the type of stroke.
A CT scan to confirm a stroke, is usually able to show whether it is an ischaemic stroke or a haemorrhagic stroke. It is like an X-ray, takes less time than an MRI scan and could mean treatment can be started more quickly.
An MRI scan is usually used for people who have recovered from a TIA or who have complex symptoms where the extent or location of the damage is unknown. An MRI scan shows brain tissue in greater detail which allows smaller bleeds on the brain or more unusual areas affected to be identified.
Tests may also be carried out to determine whether or not there has been a blockage or a narrowing of arteries in the neck. This is called a carotic ultrasound and can help confirm whether or not an Ischaemic stroke has occurred.
Echocardiogram and Transoesophageal echocardiography (TOE)
If heart problems are thought to be related to a stroke, there are tests that may be carried out; an ultrasound probe across the chest, or to find blood clots or abnormalities behind the heart, a transoesphageal echocardiography (TOE) may be carried out under sedation.
Treating Haemorrhagic strokes and brain haemorrhages
The more effective the treatment for a stroke, the better the prognosis for longterm recovery, less disability and even preventing death.
Treatments will depend on the type of stroke – whether it has been caused by a blood clot (ischaemic stroke) or by a burst blood vessel/artery (haemorrhagic stroke).
Haemorrhagic strokes occur less often than Ischaemic strokes: people who have had one may be prescribed medication to lower their blood pressure and prevent further strokes. For those taking anticoagulants when the stroke occurs – such as warfarin – treatment may be required initially to reverse the “blood thinning” effects of the medication and reduce the risk of further bleeding on the brain.
In a small number of cases emergency surgery known as a craniotomy may be required to remove blood from the brain and repair burst blood vessels. A section of the skull is removed to enable the repair and to ensure there are no blood clots present that may restrict blood flow.
Also in a small number of cases, hydrocephalus may occur which is when damage from a stroke causes a build up of spinal fluid in the brain causing symptoms such as headaches, sickness, drowsiness,vomiting and loss of balance. In this situation a tube called a shunt is inserted into the brain to drain the fluid.
Physical effects of and treatments for a stroke
So much depends upon the short and longer term impacts of a stroke. The type of stroke, it’s severity and location, and crucially the speed of diagnosis and early treatment. Recovery may be fast, or someone could require longer-term support – rehabilitation and reablement.
Treatment will start whilst in hospital, and continue once the person has been discharged back home. You can read about rehabilitation and recovery in this separate guide.