A haemorrhagic stroke is due to bleeding in or around the brain. You may also hear it called a brain haemorrhage or a brain bleed. In the UK, around 15% of strokes are haemorrhagic, and about 85% are ischaemic (caused by a blockage to the blood supply in the brain). 

There are two main types of haemorrhagic stroke: 

Intracerebral haemorrhage 
This can happen when an artery inside your brain bursts, causing bleeding within your brain.  

Subarachnoid haemorrhage 
This is due to bleeding on the surface of your brain. It happens when an artery on the surface of the brain bursts, causing bleeding into the fluid-filled space between the brain and skull

What causes a haemorrhagic stroke?

Some of the things that can cause bleeding in and around your brain include:
 
  • High blood pressure, which is a contributing factor in around half of all strokes.  
  • Cerebral amyloid angiopathy is a condition where a protein called amyloid builds up inside the blood vessels in the brain. This causes damage and makes your blood vessels more likely to tear. This condition is more common among older people.
  • An aneurysm is a weak spot on an artery, where the walls have become thin and weak. This means that they can sometimes burst, especially if you have high blood pressure. Some aneurysms are present from birth, but some things can make you more likely to develop one, including smoking, high blood pressure, and having a family history of aneurysm.
  • Anticoagulant (blood-thinning) medication. People taking medication to lower their risk of blood clots have a slightly higher risk of bleeding in the brain. However, the overall risk is very low, and your risk of stroke is carefully monitored when you’re taking blood-thinning medications.   
  • Illegal drugs, such as cocaine, can irritate blood vessel walls making them weaker and more likely to rupture. 

Diagnosis

A stroke is a medical emergency and if you have any stroke symptoms you need to call 999 immediately.
 
The quicker your stroke is diagnosed and treated, the better your recovery will be.
 
A brain scan can show what type of stroke you have had. A computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan help doctors find out whether a stroke was caused by bleeding (haemorrhagic stroke) or by a blockage (ischaemic stroke).
 
To help diagnose a subarachnoid haemorrhage, doctors may carry out a lumbar puncture. To do this they remove a small amount of the fluid that sits around your brain and spinal cord, to see if any blood has leaked into it.

Haemorrhagic stroke treatments

If you have a haemorrhagic stroke you may need surgery to stop the bleeding, remove blood or relieve any pressure that has built up around your brain.
 
This is usually done with an operation called a craniotomy. This is when a surgeon cuts away a small piece of your skull so that he or she can get to your brain and the cause of the bleeding.
 
If your stroke was caused by a burst aneurysm, an operation may be needed to seal it and stop it bleeding again.
 
You may be given medication to lower your blood pressure, or if your bleed was caused by anticoagulant medication, you will usually be given another drug to reverse the effects as soon as possible.

Recovering from a haemorrhagic stroke

It is quite common for people to experience headaches after any type of bleeding in the brain. This may be due to swelling or changes in the levels of cerebrospinal fluid. The pain tends to lessen over time and can usually be controlled by painkillers such as paracetamol. You should not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibroprofen, after this type of stroke. Drinking plenty of water and avoiding caffeine and alcohol can help to reduce these headaches. 

If you have another severe headache or a persistent headache, seek medical attention urgently.  

Some people 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.

The effects of haemorrhagic stroke are unique to each person. You can read more about the effects of stroke, rehabilitation, and support available to stroke survivors and carers.  

Find out more

  • Read our guide Bleeding in the brain: haemorrhagic stroke  to understand more about the causes of haemorrhagic stroke and how it is treated. 
  • Find out more about haemorrhagic strokes on My Stroke Guide. As well as free access to trusted advice, information and support 24/7, My Stroke Guide connects you to our online community, to find out how others manage their recovery.

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