A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open. This causes blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely. These defects may include:
People who have unhealthy lifestyle habits such as smoking, a high-fat diet, and lack of exercise
Women who take birth control pills (especially those who smoke and are older than 35)
Women who are pregnant have an increased risk while pregnant
Women who take hormone replacement therapy
Symptoms of stroke depend on which part of the brain is damaged. In some cases, a person may not know that a stroke has occurred.
Most of the time, symptoms develop suddenly and without warning. But symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.
A headache may occur if the stroke is caused by bleeding in the brain. The headache:
Starts suddenly and may be severe
May be worse when you are lying flat
Wakes you up from sleep
Gets worse when you change positions or when you bend, strain, or cough
Other symptoms depend on how severe the stroke is, and what part of the brain is affected. Symptoms may include:
Change in alertness (including sleepiness, unconsciousness, and coma)
Changes in hearing or taste
Changes that affect touch and the ability to feel pain, pressure, or different temperatures
Confusion or loss of memory
Problems writing or reading
Dizziness or abnormal feeling of movement (vertigo)
Eyesight problems, such as decreased vision, double vision, or total loss of vision
Lack of control over the bladder or bowels
Loss of balance or coordination, or trouble walking
Muscle weakness in the face, arm, or leg (usually just on one side)
Numbness or tingling on one side of the body
Personality, mood, or emotional changes
Trouble speaking or understanding others who are speaking
Exams and Tests
The doctor will do a physical exam to:
Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving.
Listen to the carotid arteries in the neck with a stethoscope for an abnormal sound, called a bruit, which is caused by abnormal blood flow.
Check for high blood pressure.
You may have the following tests to help find the type, location, and cause of the stroke and rule out other problems:
A stroke is a medical emergency. Quick treatment is needed. Call 9-1-1 or your local emergency number right away or seek urgent medical care at the first signs of a stroke.
People who are having stroke symptoms need to get to a hospital as quickly as possible.
If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.
To be effective, this treatment must be started within 3 to 4 1/2 hours of when the symptoms first started. The sooner this treatment is started, the better the chance of a good outcome.
Other treatments given in the hospital depend on the cause of the stroke. These may include:
Blood thinners such as heparin, warfarin (Coumadin), aspirin, or clopidogrel (Plavix)
Medicine to control risk factors, such as high blood pressure, diabetes, and high cholesterol
Special procedures or surgery to relieve symptoms or prevent more strokes
Nutrients and fluids
Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital. If the person has severe swallowing problems, a feeding tube in the stomach (gastrostomy tube) will likely be needed.
The goal of treatment after a stroke is to help you recover as much function as possible and prevent future strokes.
Recovery from your stroke will begin while you are still in the hospital or at a rehabilitation center. It will continue when you go home from the hospital or center. Be sure to follow up with your health care provider after you go home.
Problems moving, thinking, and talking often improve in the weeks to months after a stroke.
Many people who have had a stroke will keep improving in the months or years after their stroke.
Over half of people who have a stroke are able to function and live at home. Others are not able to care for themselves.
If treatment with clot-busting drugs is successful, the symptoms of a stroke may go away. However, patients often do not get to the hospital soon enough to receive these drugs, or they can't take these drugs because of a health condition.
People who have a stroke from a blood clot (ischemic stroke) have a better chance of surviving than those who have a stroke from bleeding in the brain (hemorrhagic stroke).
The risk for a second stroke is highest during the weeks or months after the first stroke. The risk begins to decrease after this period.
When to Contact a Medical Professional
Stroke is a medical emergency that needs to be treated right away. The acronym F.A.S.T. is an easy way to remember signs of stroke and what to do if you think a stroke has occurred. The most important action to take is to immediately call 9-1-1 for emergency assistance.
F.A.S.T. stands for:
FACE. Ask the person to smile. Check to see if one side of the face droops.
ARMS. Ask the person to raise both arms. See if one arm drifts downward.
SPEECH. Ask the person to repeat a simple sentence. Check to see if words are slurred and if the sentence is repeated correctly.
TIME. If a person shows any of these symptoms, time is essential. It is important to get to the hospital as quickly as possible. Call 9-1-1. Act F.A.S.T.
Reducing your stroke risk factors lessens your chance of a having stroke.
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Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Editorial update: 07/07/2015.