What are characteristics of a stroke caused by an intracerebral hemorrhage (select all that apply)?

Strokes caused by a break in the wall of a blood vessel in the brain are called haemorrhagic strokes (hemm-orr-ragic).

This causes blood to leak into the brain, stopping the delivery of oxygen and nutrients.

Types of haemorrhagic stroke

Haemorrhagic strokes are described by their location in the brain. There are two types:

Intracerebral haemorrhage occurs when an artery inside the brain bursts and bleeds into the brain. The most common cause is high blood pressure (hypertension).
Subarachnoid haemorrhage (SAH) is bleeding on the surface of the brain. There are 3 layers of membrane (or meninges) that cover the brain. A subarachnoid haemorrhage is a bleed that happens between the layer closest to the brain and the second layer.

Causes of haemorrhagic stroke

Haemorrhagic stroke can be caused by a number of disorders that affect the blood vessels.

High blood pressure

The main cause of haemorrhagic stroke is high blood pressure (hypertension).

Aneurysm

This is a weak or thin spot in the wall of an artery that balloons out. As the aneurysm gets bigger, it gets weaker and can burst. If the aneurysm bursts, it leaks blood into the brain.

The weak spots that cause aneurysms are usually present at birth. Aneurysms develop over a number of years, and usually don't cause detectable problems until they break.

A burst aneurysm is usually caused by high blood pressure or trauma (a sudden injury to the head).

Vascular malformations

Vascular malformations are defects of blood vessels (arteries, veins, and capillaries).

A vascular malformation is usually present at birth. It may be that as you get older the blood vessels get bigger and weaker. It can occur anywhere in the body, including the brain.

An arteriovenous malformation (AVM) is an abnormal tangled connection between arteries and veins.

A cavernous malformation is rare. It is a tangle of tiny blood vessels creating a weak walled ‘cavern’ of blood.

If the vascular malformation is in the brain and the blood vessel walls burst, then you will have a haemorrhagic stroke.

Cerebral amyloid angiopathy (CAA)

This is a build-up of a protein called amyloid in small blood vessels in the brain. The protein can damage the blood vessels and lead to bleeding.

Often the bleeding from CAA is very small and known as “microbleeds”. You might not know you have had microbleeds until they are picked up by brain imaging.

CAA is more common in older people and in people who have dementia, but sometimes it can be inherited.

Blood-thinning medication

Medications including anticoagulants and antiplatelets, which are taken to lower the risk of blood clots and ischaemic stroke, can increase your risk of haemorrhagic stroke.

Your doctor will make sure you take the right amount of blood thinner to reduce your risk of both kinds of stroke.

Illegal drugs

Some illegal drugs such as cocaine can also increase the risk of haemorrhagic stroke.

More information

See Types of stroke on EnableMe.

If you or a loved one has had a stroke, there is support available. See our help after stroke section for more information.

What is an intracranial hemorrhage?

Intracranial hemorrhage (ICH) refers to acute bleeding inside your skull or brain. It’s a life-threatening emergency. You should go to the emergency room right away or call 911 if you think you or someone you know is experiencing ICH.

There are four types of ICH:

epidural hematoma
subdural hematoma
subarachnoid hemorrhage
intracerebral hemorrhage

Epidural hematoma

A hematoma is a collection of blood, in a clot or ball, outside of a blood vessel. An epidural hematoma occurs when blood accumulates between your skull and the outermost covering of your brain.

It typically follows a head injury, and usually with a skull fracture. High-pressure bleeding is a prominent feature. If you have an epidural hematoma, you may briefly lose consciousness and then regain consciousness.

Subdural hematoma

A subdural hematoma is a collection of blood on the surface of your brain.

It’s typically the result of your head moving rapidly forward and stopping, such as in a car accident. However, it could also suggest abuse in children. This is the same type of movement a child experiences when being shaken.

A subdural hematoma is more common than other ICHs in older people and people with history of heavy alcohol use.

Subarachnoid hemorrhage

A subarachnoid hemorrhage is when there’s bleeding between the brain and the thin tissues that cover the brain. These tissues are called meninges. The most common cause is trauma, but it can also be caused by rupture of a major blood vessel in the brain, such as from an intracerebral aneurysm.

A sudden, sharp headache usually comes before a subarachnoid hemorrhage. Typical symptoms also include loss of consciousness and vomiting.

Intracerebral hemorrhage

Intracerebral hemorrhage is when there’s bleeding inside of your brain. This is the most common type of ICH that occurs with a stroke. It’s not usually the result of injury.

A prominent warning sign is the sudden onset of neurological deficit. This is a problem with your brain’s functioning. The symptoms progress over minutes to hours. They include:

headache
difficulty speaking
nausea
vomiting
decreased consciousness
weakness in one part of the body
elevated blood pressure

Most ICHs are due to a head injury. Any activities or lifestyle choices that put you at risk for a head injury can lead to ICH.

Factors that increase your risk include:

The signs and symptoms of ICH vary depending on the type, but they usually include:

a sudden and severe headache
a headache associated with a recent blow to your head
a mild and long-lasting headache
a headache accompanied by neck stiffness
confusion
drowsiness
vomiting more than twice in 24 hours
seizure
coma

ICH in children

ICH in a child can indicate child abuse. The damage may be the result of a blow to the head or by shaking the child. This can lead to shaken baby syndrome. This is a condition that occurs when violent shaking leads to serious brain damage in a child.

Other signs of child abuse are:

swollen head
retinal hemorrhages
vomiting
seizure
unconsciousness
fractures of arms and legs of different ages

Babies less than 12 months old may develop a swollen fontanel, or soft spot.

Report suspected child abuse right away by calling 911 or 1-800-4-A-CHILD (1-800-422-4453).

The first step your doctor will take to diagnose ICH is a CT scan of your head. A CT scan can show abnormalities in your brain like swelling or clots.

The CT scan may not show any sign of ICH. If you’re still having symptoms, your doctor may choose to perform a lumbar puncture, or spinal tap, to test the fluid that cushions your spine and brain.

ICH is a medical emergency. Survival depends on getting treatment right away.

It may be necessary to operate to relieve the pressure on the skull. Drilling a small hole in the skull releases blood. Drilling a larger hole or removing a piece of the skull may be necessary to remove a blood clot.

Medications

The following drugs may be necessary:

An ICH can lead to any of the following complications:

seizures
paralysis
headaches
brain development problems in children
memory loss
dizziness
difficulty concentrating

Basic preventive measures that can help avoid head injuries include the following:

Always wear a helmet when riding a bike, motorcycle, skateboard, or scooter.
Always wear your seatbelt.
If you’re of older age, try to avoid falls.
Call 911 or 1-800-4-A-CHILD (1-800-422-4453) to report suspected child abuse.

The outlook depends on the severity of the hemorrhage and how quickly you get medical care. Remember, ICH is a life-threatening condition.

Depending on the severity of the hemorrhage, draining a hematoma can lead to recovery. Physical or occupational therapy is sometimes needed to help you return to normal activities.

ABOUT DIAGNOSIS TREATMENT

A hemorrhagic stroke occurs when blood from an artery suddenly begins bleeding into the brain. As a result, the part of the body controlled by the damaged area of the brain cannot work properly.

There are two main types of hemorrhagic stroke:

Intracranial hemorrhages, when the bleeding occurs inside the brain
Subarachnoid hemorrhages, when the bleeding occurs between the brain and the membranes that cover it

When the stroke is caused by a blockage in an artery that reduces blood flow to the brain, this is known as an ischemic stroke.

A person experiencing symptoms of a stroke needs immediate emergency care. The sooner medical treatment begins, the fewer brain cells are damaged.

The signs of a stroke are:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion
Sudden trouble speaking
Sudden trouble seeing in one or both eyes
Sudden trouble walking
Sudden dizziness, loss of balance or coordination
Sudden, severe headache with no known cause

Symptoms of intracranial hemorrhages and subarachnoid hemorrhages include:

A sudden, severe headache
Changes in vision
Loss of balance or coordination
Weakness, inability to move or numbness in an arm or leg
Seizures
Loss of speech or difficulty understanding speech
Confusion or loss of alertness
Nausea and vomiting
Loss of consciousness

Additional symptoms may include:

Paralysis of one side of the body
Sensitivity to light
Stiffness in the neck or neck pain
Frequent fluctuations in the heart beat and breathing
Hand tremors
Difficulty swallowing
Abnormal taste in the mouth

Causes and Risk Factors

Hemorrhagic stroke is caused by sudden bleeding from a blood vessel inside the brain or in the spaces around the brain. Sudden bleeding may result from:

Uncommon causes of hemorrhagic stroke include inflamed blood vessels or radiation treatments.

Diagnosis of a hemorrhagic stroke is based on a thorough medical history and physical exam, and doctors may strongly suspect bleeding inside the skull based on the patient’s symptoms.

In cases where a stroke is suspected, imaging tests can help determine whether the stroke was caused by a clot (ischemic stroke) or by bleeding inside the brain (hemorrhagic). Imaging tests include magnetic resonance imaging (MRI) or computed tomography (CT) scans. An electroencephalogram (EEG) or lumbar puncture (spinal tap) may be done to confirm the diagnosis of a hemorrhagic stroke.

Tests may be done to check for other conditions, check the patient’s overall health, and see if the patient's blood clots too easily.

Patients who have symptoms of a hemorrhagic stroke need to seek immediate emergency medical care. Prompt medical attention may prevent life-threatening complications and more widespread damage to the brain.

Treatment for a hemorrhagic stroke depends on what caused it, where it's located and the size of the hemorrhage. Treatment options include interventional radiology or neurosurgical procedures, such as surgical clipping or coil embolization, which may also be performed to stop the bleeding and reduce the pressure in the brain. Medicines to reduce swelling, prevent seizures and reduce pain also may be given.

The goals of treatment are to prevent life-threatening complications that may occur soon after stroke symptoms develop, prevent future strokes, reduce disability, prevent long-term complications and help the patient get back as much normal functioning as possible through rehabilitation.