Haemorrhagic Stroke

What is this condition?

Haemorrhagic stroke is bleeding within the brain or around it. Causes include chronic hypertension, cerebral amyloid angiopathy, aneurysm, arteriovenous malformation, tumour, blood-thinning medicine or a bleeding disorder. The blood directly injures tissue and can also raise pressure, obstruct CSF and trigger further swelling.

What symptoms can it cause?

• Sudden severe headache, vomiting or collapse
• Weakness, speech loss, facial droop or severe imbalance
• Reduced consciousness, repeated vomiting or seizure
• Symptoms may worsen during the first hours

How is it assessed and diagnosed?

Urgent CT confirms the site and volume. CT angiography, catheter angiography or MRI looks for an aneurysm, vascular malformation, venous thrombosis, tumour or other cause. Medication history, blood pressure, clotting tests and platelet count guide immediate treatment. Repeat imaging may be needed if the condition changes.

Treatment without surgery

Neurocritical care addresses airway, blood pressure, anticoagulant reversal, glucose, temperature, seizures and intracranial pressure. Selected small stable bleeds are managed without surgery with close monitoring and repeat examination. Rehabilitation begins when the patient is medically stable.

When is surgery or a procedure considered?

Surgery is individualized. Options include open clot evacuation, minimally invasive evacuation, external ventricular drainage for hydrocephalus, decompression for dangerous pressure, or treatment of an underlying aneurysm or malformation. Location, volume, age, neurological state, timing and expected function all matter; surgery cannot undo tissue already destroyed by bleeding.

Treatment and procedure options

• Close neurocritical observation and medical treatment
• External ventricular drain
• Open or minimally invasive clot evacuation
• Decompressive craniectomy
• Clipping, coiling or vascular-malformation treatment when indicated

Risks from the disease and from treatment

Rebleeding, swelling, hydrocephalus, herniation, seizures, pneumonia, clots and disability may occur. Surgery carries bleeding, infection and new neurological injury, but in selected patients it may prevent deterioration or save life. Prognosis depends heavily on the initial brain injury. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

Recovery often involves prolonged nursing and rehabilitation. Swallowing, chest care, pressure-area protection, mood and caregiver training are important. Follow-up searches for the cause and controls blood pressure and other modifiable risks. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• AANS — Intracerebral Hemorrhage: https://www.aans.org/patients/conditions-treatments/intracerebral-hemorrhage/
• CDC — Stroke: https://www.cdc.gov/stroke/about/index.html