What is a haemorrhagic stroke?

What is a haemorrhagic stroke?

Haemorrhagic stroke is when you have bleeding in or around the brain. This damages your brain cells, and can affect how your body works, as well as how you think and feel.

It’s a less common type of stroke, and around 15% of strokes in the UK are haemorrhagic. The other 85% of strokes are ischaemic (due to a blockage in the blood supply to the brain).

What happens when you have a haemorrhagic stroke?

If you have a haemorrhagic stroke, you will have emergency treatment to reduce bleeding and limit the amount of damage in the brain. Afterwards, you will have support for your recovery including medical treatment and rehabilitation therapy.

The effects of your stroke depend on where the stroke was in your brain, and the amount of damage.

There are two main types of haemorrhagic stroke

1. Bleeding within the brain (intracerebral haemorrhage, or ICH).
2. Bleeding on the surface of the brain (subarachnoid haemorrhage, or SAH).

1. Bleeding within the brain

Intracerebral haemorrhage (ICH) is where blood leaks out of a blood vessel into the brain tissue, sometimes deep inside the brain. ICH is the most common type of haemorrhagic stroke, and around two thirds of all haemorrhagic strokes are ICH.

2. Bleeding on the surface of the brain

Subarachnoid haemorrhage (SAH) is where blood leaks out of a blood vessel on the surface of the brain, and gets into the protective layer of fluid surrounding the brain. This layer is known as the subarachnoid space.

SAH is the least common type of stroke, and around one in three of all haemorrhagic strokes are SAH (about one in 20 of all strokes).

What is the subarachnoid space?

The brain is surrounded by a double layer of protective membranes, with cerebrospinal fluid in between. This layer of fluid is called the subarachnoid space, and it helps to cushion the brain from injury.

Symptoms of a haemorrhagic stroke

The most typical symptom of a haemorrhagic stroke is a sudden, severe headache, sometimes called a thunderclap headache.

People describe a thunderclap headache as the worst pain they have ever had, and like being hit on the head. If you or someone you know has a thunderclap headache, even if it goes away by itself or with painkillers, you should call 999.

Other common symptoms are a stiff neck, nausea and vomiting. You can also have any of the signs of stroke in the FAST test.

The FAST test helps to spot the three most common symptoms of a stroke. But there are other signs that you should always take seriously. These include:

• Sudden weakness or numbness on one side of the body, including legs, hands or feet.

• Difficulty finding words or speaking in clear sentences.

• Sudden blurred vision or loss of sight in one or both eyes.

• Sudden memory loss or confusion, and dizziness or a sudden fall.

• A sudden, severe headache.

If you spot any of these signs of a stroke, don’t wait. Call 999 straight away.

Tests and checks for diagnosing stroke

When someone is taken to hospital with a suspected stroke, a brain scan should be carried out urgently and if possible within one hour of arriving in hospital. The scan could be either a computed tomography (CT) or magnetic resonance imaging (MRI) scan. Scans can help doctors decide if you have had a stroke, and if you need other tests.

Other tests and checks for haemorrhagic stroke include:

• Computed tomography (CT) scan: shows if there is bleeding in or around the brain.

• Lumbar puncture: This looks for blood in the cerebrospinal fluid (the fluid around your brain and spinal cord), which can be a sign of bleeding around the brain (subarachnoid haemorrhage). The fluid is taken from your lower spine using a very thin needle, and it’s done under local anaesthetic.

• Digital subtraction angiogram or catheter angiogram: this uses X-rays to find the burst blood vessel. A fine tube called a catheter is put into an artery, usually in the groin. A liquid called a contrast, or dye, is injected into the blood to make the blood vessels show up on an X ray and find any bleeding.

Treating haemorrhagic stroke

Medication

After an SAH, the blood vessels in the brain can become narrowed, reducing the blood flow in the brain (vasospasm). This causes more stroke symptoms and can be very serious. Vasospasm can happen from around a day to three weeks after the stroke. To prevent it, you may be given a drug called nimodipine for about three weeks.

If you are taking warfarin (a blood-thinning medication), you may be given medication to reverse the effects.

If you have high blood pressure, you will be given medication to bring it down. You will be offered painkillers to help with the severe headache associated with an SAH.

Surgery

As well as surgery to repair aneurysms, other procedures can sometimes be used to deal with the impact of haemorrhagic stroke on the brain.

Procedure to relieve pressure on the brain (craniotomy)

Occasionally, pressure can build up inside the skull due to bleeding or swelling of the brain. A craniotomy is a surgical procedure where part of the skull is removed to reduce pressure on the brain, and allow the surgeon to repair damaged blood vessels.

Shunt surgery for hydrocephalus (excess fluid in the brain)

A subarachnoid haemorrhage (SAH) can sometimes lead to a dangerous buildup of fluid around the brain, known as hydrocephalus. This happens when the flow of cerebrospinal fluid that normally surrounds the brain and spinal cord is disrupted. Symptoms include headache and vomiting, as well as other stroke-like symptoms.

The main treatment for hydrocephalus is shunt surgery. A shunt is a thin tube implanted in the brain to drain the fluid away to another part of your body. There is a valve attached, which you can feel under the skin on your scalp.

Seizures

Some people have a seizure after a haemorrhagic stroke. Having a seizure doesn’t mean you will go on to develop epilepsy. You will be assessed to help decide the best treatment for you, which might include epilepsy medication, depending on your age and your risk of developing epilepsy.

For more information about seizures and epilepsy after stroke visit stroke.org.uk/epilepsy.

Headaches after haemorrhagic stroke

While you are recovering from a haemorrhagic stroke or treatment such as surgery, you might have headaches which can often be treated with painkillers. Ask your GP or pharmacist for advice about what type of painkillers you can use.

Some people also report strange sensations in their brain after an SAH, like running water or a tickling feeling on their brain. These are quite common and usually pass in time.

If you have a very sudden, severe headache or a headache that doesn’t go away, seek medical attention urgently

Recovering from a haemorrhagic stroke

Everyone recovers differently. Some people recover fully, and other people will have health problems or a disability.

The fastest recovery takes place in the first few months. After that progress can be slower, but you can continue to improve for months or years after a stroke.

How will my stroke affect me?

The effects of a stroke are unique to each individual. A stroke can affect any part of your body, as well as your communication, emotions, and memory and thinking.

Find out more about all the effects of stroke in our guide ‘Next steps after a stroke’ or visit stroke.org.uk/effects-of-stroke.

Rehabilitation and recovery

You should receive rehabilitation soon after your stroke. It may begin in hospital and should carry on at home if you need it.

During rehabilitation, the therapist assesses you, and designs treatment tailored to your needs. Depending on the type of therapy, you may have exercises to practise. You may work towards building up stamina, or learn new ways of doing things.

Support after leaving hospital

Hospital discharge

When you are able to leave hospital, the discharge process should ensure that you get all the support you need including your medical treatment, rehabilitation therapy, care and equipment. You and your family will be involved in planning your discharge.

Post-stroke review

Around six months after you leave hospital, you should get a review of your progress. This makes sure you are getting the right support if your needs have changed, including rehabilitation.

If a review does not take place, contact your GP.

You can read more about the causes and effects of haemorrhagic stroke in our PDF linked below.

Information guides

• Download Bleeding in the brain: haemorrhagic stroke guide (PDF)
• Download When you have a stroke guide (PDF)

Where to get help and information from the Stroke Association

Helpline
Call us on 0303 3033 100,from a textphone 1800 0303 3033 100
Email: helpline@stroke.org.uk
Our Helpline offers information and support for anyone affected by stroke, including family, friends and carers.

Read our information
Call the Helpline to ask for printed copies of our guides.

Other sources of help and information

Blood Pressure UK
Helpline: 020 7882 6218
Has a wide range of information on high blood pressure, treatments and lifestyle.

Brain & Spine Foundation
Helpline: 0808 808 1000
Provides detailed information about neurological conditions and risk factors, including subarachnoid haemorrhage and vascular malformations of the brain. Their helpline is staffed by specialist nurses.

Brain and Spinal Injury Centre (Basic)
Helpline: 0870 750 0000
Provides information, support and advice by staff who have direct experience of brain injury.

Chest, heart & stroke Scotland
Advice Line: 0808 801 0899
Information and support for people affected by stroke in Scotland

DVLA (England, Wales, Scotland)
Website: gov.uk/dvla
Gives information about driving after stroke.

DVA (Northern Ireland)
Gives information about driving after stroke.

Headway: the brain injury association
Tel: 0808 800 2244
Has information on strokes due to bleeding and aneurysms. They also have a network of local branches.

Disclaimer: The Stroke Association provides the details of other organisations for information only. Inclusion on My Stroke Guide does not constitute a recommendation or endorsement.