What is a Hemorrhagic Stroke?

A hemorrhagic stroke (HS) is characterized by bleeding in a part of the brain due to the rupture of a blood vessel. This bleeding can occur within the brain or brainstem (known as intraparenchymal hemorrhagic stroke) or within the meninges (known as subarachnoid hemorrhage). Intraparenchymal hemorrhage (IPH) is the most common subtype of brain hemorrhage.

This type of stroke mainly occurs as a result of high blood pressure or a condition called cerebral amyloid angiopathy. In these conditions, the walls of the brain arteries become more fragile and rupture, causing bleeding.

Risk factors for hemorrhagic stroke include:

high blood pressure: When elevated, it can damage arteries over time, making them more prone to rupture
smoking: Chemicals in cigarettes can damage blood vessels and accelerate plaque buildup in arteries.
diabetes
high LDL cholesterol (commonly known as "bad" cholesterol): Can lead to plaque buildup in arteries and increase the risk of blockages
obesity
family history: If someone in the family has had a stroke, the likelihood of relatives or children having one is higher than in those without a family history
advanced age, especially after age 55
gender: Men tend to have a slightly higher risk than women; however, women are more likely to experience strokes during pregnancy or due to hormonal contraceptive use
atrial fibrillation: A heart rhythm disorder that increases the risk of blood clots forming in the heart, which can travel to the brain and cause a stroke
excessive alcohol consumption: Can raise blood pressure and contribute to blood clot formation.
use of illicit drugs, such as cocaine, which can increase risk due to their effects on the cardiovascular system

Symptoms of a Hemorrhagic Stroke

The signs and symptoms are always sudden and may include:

weakness on one side of the body
loss of sensation or visual field in one or both eyes
dizziness
difficulty speaking or understanding simple words
loss of consciousness
seizures

Diagnosis

The diagnosis is made through neuroimaging tests, such as a cranial CT scan or magnetic resonance imaging (MRI). These exams must be performed immediately upon arrival at the hospital emergency department, as they reveal the location and size of the hemorrhage.

Treatment

Treatment can be surgical or clinical, depending on the volume of the lesion, its location, and the patient’s clinical condition. Even patients who undergo surgery must receive clinical support and rehabilitation.

Surgical treatment aims to remove the blood from inside the brain. In some cases, a catheter is placed to monitor intracranial pressure, which can increase due to brain swelling after the hemorrhage. In certain situations, surgery is not performed immediately upon hospital admission, especially because some patients may experience a second hemorrhage a few hours after the first.

Clinical treatment focuses on controlling blood pressure and managing complications such as seizures and infections.

Rehabilitation should begin as soon as the patient is no longer at risk of neurological or clinical deterioration. It is an essential part of treatment and typically involves a multidisciplinary team, including speech therapy, physical therapy, nursing, and occupational therapy. These professionals work together to develop a personalized care plan based on the patient’s specific neurological impairments, aiming to improve their quality of life.

Prevention

It is recommended to engage in at least 150 minutes (2.5 hours) of moderate physical activity per week to maintain cardiovascular health.

In addition, it is important to adopt a diet rich in fruits, vegetables, whole grains (such as brown rice, corn, and beans), and omega-3-rich fish. Avoid the consumption of saturated fats (like heavy cream and butter), trans fats (such as chips, chocolates, and microwave popcorn), and sodium (salt). Regular check-ups with a healthcare professional are essential to maintain a healthy weight and to monitor your health through routine exams.

By the Einstein Editorial Board