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Haemorrhagic stroke


Expert reviewer, Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician
Next review due February 2022

Haemorrhagic stroke is when the blood supply to your brain is cut off when a blood vessel bursts and bleeds (haemorrhages) into your brain. This stops your brain getting the oxygen and nutrients it needs, and the blood puts pressure on your brain, which can damage it. The sooner you get treatment for a haemorrhagic stroke (also known as a brain haemorrhage), the better your chances of reducing the damage.

Types of haemorrhagic stroke

There are different types of stroke. This topic is about haemorrhagic stroke (brain haemorrhage), but we also have information about ischaemic stroke.

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 (a brain bleed) 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.

Causes of haemorrhagic stroke

A haemorrhagic stroke (brain haemorrhage) 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 intracerebral haemorrhage type of haemorrhagic stroke, or brain bleed, 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.

  • Your ethnicity. If you’re Asian descent, you’re more likely to have an intracerebral haemorrhage compared with other ethnic groups.
  • 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. For more information about what an arteriovenous malformation is, see Frequently asked questions below.
  • Anything that increases your tendency to bleed. This could be treatment with an anticoagulant medicine that reduces your blood’s ability to clot (eg, 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. For more information about how cocaine can cause a stroke, see Frequently asked questions below.
  • Drinking too much alcohol may increase your risk of a haemorrhagic stroke.

Symptoms of haemorrhagic stroke

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.
  • Arms. You won't be able to raise your arms and hold them 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 headache – this may be sudden, and very severe, or gradually get worse if you have a intracerebral haemorrhage
  • 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
  • losing your balance
  • feeling dizzy
  • vertigo
  • blurred or double vision – or difficulty seeing at all
  • sensitivity to light
  • feeling confused
  • fits (seizures)

Diagnosis of haemorrhagic stroke

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.

The tests will include:


Lumbar puncture

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.

Angiogram

You may need to have an angiogram to find out exactly where the bleeding in your brain is coming from. In this test, your doctor will inject a dye into your blood vessels to make them show up on X-rays and scans.

Treatment of haemorrhagic stroke

You may receive treatment for a haemorrhagic stroke (brain haemorrhage) 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 need some support 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). They may also give you 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.

Medicines for haemorrhagic stroke

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.

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Surgery for haemorrhagic stroke

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 advise you which type of surgery is best for you.

The types and reasons for having surgery are outlined below.

Surgery to deal with bleeding and clots

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 different types of surgery to do this.

One type of operation 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. Your surgeon will use a needle or endoscope (a very small tube-like telescopic camera) to do this. 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.

Surgery to prevent more bleeding

You may need surgery to reduce the chance of more bleeding (rebleeding). If bleeding is caused by an aneurysm (see our causes section below for 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 (or radiologist) will pass a tube through a small cut in your groin into an artery. They’ll 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.

Surgery to drain fluid

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 can cause pain. 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.

Rehabilitation after haemorrhagic stroke

A stroke can damage your brain. Since your brain controls everything you do, you may need to relearn skills and abilities, or learn to adapt to new ways of doing things. This is known as stroke rehabilitation.

It can be difficult to know 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. They’ll work together to help you stay as independent as possible.

Complications of haemorrhagic stroke

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
  • headaches
  • difficulty swallowing
  • feeling tired and problems sleeping
  • problems with speech, reading and writing
  • problems with your sight – eg, you might get double vision
  • feeling confused and less awareness of where you are
  • problems with thinking, and memory, and difficulty concentrating
  • difficulty controlling your bladder and bowel movements (incontinence or constipation)
  • changes in your behaviour
  • anxiety and depression
  • seizures (fits) – these may develop into epilepsy

If you can’t move because of stroke, you could be at risk of:

  • bed sores (pressure ulcers)
  • deep vein thrombosis (DVT) – this is a blood clot in a vein in your leg
  • pneumonia
  • contractures (where your hands, feet, arms or legs become so tight that it’s hard to straighten them)

Prevention of haemorrhagic stroke

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 help to 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.

Frequently asked questions

  • 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 fits (seizures).

    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 you have a AVM that’s likely to burst and bleed, your doctor may suggest you have an operation to remove it. Other treatment options 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 stereotactic 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 ‘vasospasm’ 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.


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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, February 2022
    Expert reviewer, Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician
    Next review due February 2022



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