About 15 people out of every 100 who have a stroke have a haemorrhagic stroke. And there are two main types.
- Intracerebral haemorrhage. This is caused by bleeding from a blood vessel inside your brain and is the most common type.
- Subarachnoid haemorrhage. This is caused by bleeding from a blood vessel on the surface of your brain into the subarachnoid space. This is an area between your brain and the lining that covers it and contains cerebrospinal fluid that surrounds your brain and spine.
The symptoms of a stroke usually come on suddenly, within seconds or minutes.
It’s vital that you can recognise if you, or someone you’re with, is having a stroke so you can get immediate treatment. A good way to remember the signs of one is to use the ‘FAST’ test.
- Face. If you’ve had a stroke, your face may feel weak and you won't be able to smile. Your mouth or eye may droop down, usually just on one side.
- Arm. You won't be able to raise your arm and hold it there.
- Speech. You may have slurred speech or find it difficult to remember the names of common objects.
- Time to call 999. If you have one or more of these symptoms, or you see them in anyone else, get emergency help straightaway.
Other symptoms of a haemorrhagic stroke may include:
- a sudden, very severe headache
- losing consciousness
- feeling sick or vomiting
- a stiff neck
- feeling numb or weak, or unable to move your face, arm or leg on one side of your body
- feeling dizzy
- blurred or double vision – or difficulty seeing at all
- feeling confused
- seizures (fits)
When you get to hospital, you’ll have some tests to find out what type of stroke you’ve had and how your brain is affected. This will help your doctor to plan your treatment.
- a brain scan such as a computer tomography (CT) or magnetic resonance imaging (MRI) to find out what caused your stroke
- an electrocardiogram (ECG) to record the rhythm and electrical activity of your heart
- blood tests to measure your pressure, cholesterol and blood sugar levels, and to check how well your blood clots
If your doctor thinks you had a subarachnoid haemorrhage, but your brain scan doesn’t clearly show the bleeding, you may need a lumbar puncture. This test involves taking a sample of the fluid that surrounds your brain and spine from your lower back. This will be tested to see if there’s any blood from your brain in it, which would confirm that you had a haemorrhagic stroke.
If a lumbar puncture does confirm that you’ve had a haemorrhagic stroke, you may need to have an angiogram. In this test, your doctor will inject a dye into your blood vessels to make them show up on X-rays and scans. It will help to find out exactly where the bleeding in your brain is coming from.
You may be treated in a specialist stroke unit in hospital.
If you can’t swallow, you’ll be given fluid through a drip in your arm to stop you getting dehydrated. And you’ll have a tube in your nose to give you the nutrients and medicines you need. You might also be given oxygen through a face mask to help you breathe.
Nurses will help you to sit up and encourage you to move around as soon as you can. If you can’t move, they’ll help you to turn in your bed regularly. This will reduce your risk of getting bed sores and deep vein thrombosis (DVT). You may also be given a mechanical pump to use on your feet and legs called an intermittent compression device. The pump automatically squeezes your feet and lower legs to help keep your blood moving and prevent a blood clot from forming.
How long you’ll need to stay in hospital will depend on how severe your stroke was and how you’ve been affected by it.
The medicines your doctor will give you will depend on the type of haemorrhagic stroke you've had, and if you’re taking any other medicines.
If you’ve had an intracerebral haemorrhage and are taking an anticoagulant, you may need to take medicines that have the opposite effect. An anticoagulant is a medicine that reduces the ability of your blood to clot. Taking a medicine that has the opposite effect will allow your blood to clot and help stop further bleeding in your brain.
You might also need to take:
- anticonvulsants, which can help to prevent seizures
- antihypertensives to lower your blood pressure if it’s very high, to prevent further bleeding
- diuretics to lower the pressure in your brain if it’s very high
If you have a subarachnoid haemorrhage, you may need to take a medicine called nimodipine for a few weeks afterwards. This will help to keep the blood flowing in your brain.
If you’ve had a haemorrhagic stroke, you might need to have surgery. Which type of surgery you have will depend on the type of haemorrhagic stroke you’ve had and your own personal circumstances. Your doctor or surgeon will be able to advise which type of surgery is best for you.
The types and reasons for having surgery are outlined below.
Bleeding in your brain from a haemorrhagic stroke can cause pressure to build up and clots to form. You might have surgery to drain the bleed and remove any blood clots – this is known as evacuation. There are lots of different types of surgery to do this. One type involves removing a piece of your skull (known as craniotomy). During this procedure your surgeon can fix the blood vessel, drain the bleed and remove any clots. Other types of surgery involve drilling small holes in your skull and then draining the bleed and any clots using a needle or endoscope (a very small tube-like telescopic camera). Other procedures, involve using CT (computed tomography) to find out where the bleed is, and then a special piece of equipment to suck up the bleed and any clots.
You may also need surgery to reduce the chance of more bleeding (rebleeding). If bleeding is caused by an aneurysm (see our causes section below for more information), you may have a procedure called endovascular coiling. This stops blood pooling into the aneurysm, reducing the chance of it bursting again. In this procedure, your surgeon passes a tube through a small cut in your groin into an artery. They thread this through to reach the aneurysm in your brain and then put small coils in it. This is the most common procedure, but you may have a craniotomy. During the craniotomy, your surgeon puts a clip around the base of the aneurysm to stop it bleeding again.
Some haemorrhagic strokes might cause the amount of cerebral spinal fluid in your brain to increase (hydrocephalus). This raises the pressure in your brain and makes you feel less alert. If this happens, you might need to have the fluid removed. Procedures such as ventricular drainage and lumbar puncture can be used to relieve the pressure. Lumbar puncture is a procedure that might also be used to help diagnose haemorrhagic stroke – see our diagnosis section for more information.For more information on surgery for haemorrhagic stroke, talk to your doctor or surgeon
A stroke can damage your brain. Since your brain controls everything you do, you may need to relearn skills and abilities, or learn new ways of doing things. This is known as stroke rehabilitation.
It can be difficult to predict how well you’ll recover from a stroke. You might make most of your recovery in the first weeks and months after the stroke. But you might continue to get better and carry on improving for years afterwards.
A multidisciplinary team of health professionals will work out a rehabilitation programme for you that's designed around your needs. The team may include physiotherapists, speech and language therapists, occupational therapists, ophthalmologists and psychologists, as well as doctors and nurses. They’ll work together to help you stay as independent as possible.
A haemorrhagic stroke is caused by a blood vessel within your skull bursting and bleeding into and around your brain. High blood pressure plays a part in most haemorrhagic strokes – this puts extra strain on your smaller blood vessels so they’re more likely to burst.
You’re also more at risk of having a haemorrhagic stroke as you get older. Although you can have a stroke at any age, most people who have one are over 65. And men are more likely to have one than women. Other things that may increase your risk of having a haemorrhagic stroke include the following.
- An aneurysm in your brain, which is a weak spot in your artery wall that widens or bulges outwards and can sometimes burst. An aneurysm can be caused by smoking or high blood pressure, or some people have a family history of them.
- Cerebral amyloidosis, which is a condition where a substance called amyloid builds up in the blood vessels in your brain. This can damage your blood vessels so they may burst and bleed.
- Abnormalities in the way that blood vessels have formed in your brain. This is called an arteriovenous malformation or a cavernoma. See FAQ: What’s arteriovenous malformation? for more information.
- Anything that increases your tendency to bleed. This could be treatment with an anticoagulant medicine that reduces your blood’s ability to clot (for example, warfarin). Or it may happen if you have a health condition that affects how your blood clots, such as haemophilia.
- Using illegal drugs, such as cocaine. See FAQ: Cocaine and haemorrhagic strokes below.
- Drinking too much alcohol increases your risk of a haemorrhagic stroke too.
A haemorrhagic stroke can be very severe and cause lasting damage to your brain. Sometimes it can even be fatal. Complications of a stroke include:
- weakness or paralysis, often on one side of your body
- difficulty swallowing
- problems sleeping
- problems with speech, reading and writing
- problems with your sight – for example, you might get double vision or find it hard to see
- problems with your memory and difficulty concentrating
- difficulty controlling your bladder and bowel movements (incontinence or constipation)
- changes in your personality and behaviour
- anxiety and depression
If you can’t move because of stroke, you could be at risk of:
- bed sores (pressure ulcers)
- DVT (deep vein thrombosis) – this is a blood clot in a vein in your leg
- contractures (where your hands, feet, arms or legs become so tight that it’s hard to straighten them)
High blood pressure plays a part in most haemorrhagic strokes so you could take steps to reduce this. For tips on how, see our topic on high blood pressure.
You can also prevent a haemorrhagic stroke by not using illegal drugs such as cocaine. If you drink a lot of alcohol or smoke, it’s a good idea to cut down. And try to eat well. See Related information for tips and advice on achieving these.
Haemorrhagic strokes are often more severe than ischaemic strokes and are also more likely to be fatal, but everyone is different. Both haemorrhagic and ischaemic strokes can be fatal for some people, whereas others recover well and manage with the effects of a stroke.
An arteriovenous malformation (AVM) is a tangle of blood vessels that forms when your blood vessels don't connect together properly in your brain. Most people aren’t aware they have an AVM as they don’t usually cause any problems. But you might get symptoms such as headaches and seizures (fits).
Your arteries are connected to your veins by a network of very fine blood vessels called capillaries. In an AVM, the capillaries are missing and your arteries and veins join together in a complex tangle of weakened blood vessels. Over time, the pressure of the blood in the tangle can eventually lead to a blood vessel bursting, which is called a haemorrhage.
If your doctor finds out that you have an AVM, they’ll probably want to monitor it. If it’s likely to burst and bleed, they may suggest you have an operation to remove it. Other treatments involve blocking the blood vessels that make up the AVM with a glue-like material (embolisation), or destroying it with focused radiation beams. This is called gamma knife radiosurgery.
Cocaine causes your blood vessels to suddenly narrow, which can slow down or stop the flow of blood through them. This is called a ‘spasm’ and can weaken your blood vessels and make them more likely to burst. Taking cocaine can also lead to a sudden, temporary rise in blood pressure, which increases your risk of a haemorrhagic stroke too.
- Stroke Association
0303 303 3100
- Haemorrhagic stroke. BMJ Best Practice. bestpractice.bmj.com, last updated 26 April 2016
- Hemorrhagic stroke. Medscape. emedicine.medscape.com, updated 8 January 2015
- Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. National Institute for Health and Care Excellence (NICE), 23 July 2008. www.nice.org.uk
- Brain anatomy. Medscape. emedicine.medscape.com, updated 24 April 2015
- Map of medicine. Stroke and transient ischaemic attack (TIA). International view. London: Map of medicine; 2016 (issue 2)
- Stroke and TIA. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised December 2013
- Subarachnoid haemorrhage. PatientPlus. patient.info/patientplus, last checked 14 January 2015
- National clinical guideline for stroke. Royal College of Physicians. www.rcplondon.ac.uk, published September 2012
- Oral anticoagulants. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 19 August 2016
- Nimodipine. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 19 August 2016
- Cerebrovascular event rehabilitation. PatientPlus. patient.info/patientplus, last checked 2 August 2013
- NINDS stroke information page. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov, last modified 26 May 2016
- Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning. Scottish Intercollegiate Guidelines Network (SIGN), June 2010. www.sign.ac.uk
- Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45(12):3754–832. doi: 10.1161/STR.0000000000000046
- Arteriovenous malformations. Medscape. emedicine.medscape.com, updated 27 March 2014
- Stroke Association
We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short form below will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.
Let us know what you think using our short feedback form Ask us a question
Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, October 2016
Expert reviewer Dr Ahamad Hassan, Consultant Neurologist and Stroke
Next review due October 2019
About our health information
At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. Here are just a few of the ways in which our core editorial principles have been recognised.
We are certified by the Information Standard. This quality mark identifies reliable, trustworthy producers and sources of health information.
What our readers say about us
But don't just take our word for it; here's some feedback from our readers.
“Simple and easy to use website - not alarming, just helpful.”
“It’s informative but not too detailed. I like that it’s factual and realistic about the conditions and the procedures involved. It’s also easy to navigate to areas that you specifically want without having to read all the information.”
“Good information, easy to find, trustworthy.”
Meet the team
Head of Health Content
- Dylan Merkett – Lead Editor
- Natalie Heaton – Specialist Editor, User Experience
- Pippa Coulter – Specialist Editor, Content Library
- Alice Rossiter – Specialist Editor, Insights
- Laura Blanks – Specialist Editor, Quality
- Michelle Harrison – Editorial Assistant
Our core principles
All our health content is produced in line with our core editorial principles – readable, reliable, relevant – which are represented by our diagram.
In a nutshell, our information is jargon-free, concise and accessible. We know our audience and we meet their health information needs, helping them to take the next step in their health and wellbeing journey.
We use the best quality and most up-to-date evidence to produce our information. Our process is transparent and validated by experts – both our users and medical specialists.
We know that our users want the right information at the right time, in the way that suits them. So we review our content at least every three years to keep it fresh. And we’re embracing new technology and social media so they can get it whenever and wherever they choose.
Here are just a few of the ways in which the quality of our information has been recognised.
The Information Standard certification scheme
You will see the Information Standard quality mark on our content. This is a certification programme, supported by NHS England, that was developed to ensure that public-facing health and care information is created to a set of best practice principles.
It uses only recognised evidence sources and presents the information in a clear and balanced way. The Information Standard quality mark is a quick and easy way for you to identify reliable and trustworthy producers and sources of information.
Certified by the Information Standard as a quality provider of health and social care information. Bupa shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of Bupa.
British Medical Association (BMA) patient information awards
We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.
If you have any feedback on our health information, we would love to hear from you. Please contact us via email: firstname.lastname@example.org. Or you can write to us:
Health Content Team
15-19 Bloomsbury Way