Strokes are the 3rd most common cause of death in the U.S. and encompass a large variety of events that lead to neurologic injury. Hemorrhagic strokes represent 20% of all cerebrovascular accidents (CVA). The presentation and management are different than an ischemic stroke and the prognosis is much worse. There are 2 types of hemorrhagic stroke: intracerebral and subarachnoid.

Intracerebral hemorrhage results from bleeding within the brain tissue, which usually starts in the small arteries. As the bleeding grows it spreads around the brain and causes a hematoma. The hematoma may stabilize and eventually resolve on its own. The greatest concern occurs when the bleeding continues, causing a larger hematoma. As the hematoma grows it damages the brain by compressing the surrounding tissue causing swelling.

The presenting symptoms are based on the region of the brain affected but they can go un-noticed for some time. The symptoms may include weakness, problems walking, difficulty speaking. As the hematoma grows it can cause headaches, nausea, vomiting and loss of consciousness. The most common cause of this type of stroke includes hypertension, trauma, and rupture of a vascular malformation. This is also more likely to occur in illicit drug users and those with a bleeding tendency. Other less common causes include bleeding from a tumor, a ruptured aneurysm and vasculitis (an inflammatory condition of the blood vessels).

A subarachnoid hemorrhage occurs with sudden acute bleeding into the fluid surrounding the brain and spinal cord within the subarachnoid space that surrounds the brain. A large amount of blood in the cerebrospinal fluid increases the pressure within this delicately balanced area. This increased pressure can cause a shift in the brain structures. Edema usually develops. This shift in the structures and associated edema will compromise neurologic function if prompt treatment is not given.

The amount of blood loss is usually large contributing to a sudden onset of symptoms such as headache, fainting, memory loss and vomiting. The phrase “worse headache of my life” is commonly used to describe the severity of the pain. This type of bleeding usually results from a ruptured aneurysm or some other type of vascular malformation and represents a life-threatening emergency. If left untreated death or coma can occur rapidly.

Symptoms of sudden severe headache, especially associated with vomiting and loss of consciousness require prompt medical care. Even though there are many other potential causes; a hemorrhagic stroke is the one that needs to be considered first. Health care providers only have a short period of time to intervene to save the affected person. If you or someone you know are experiencing these symptoms, seek care immediately.

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