Stroke – Hemorrhagic

Hemorrhagic stroke is a type of intracranial hemorrhage. There are two types of hemorrhagic stroke:

  • Intracerebral Hemorrhage (ICH)
  • Subarachnoid Hemorrhage (SAH)

Although there may be some overlap between ICH and SAH, they often represent distinctly different conditions. More detail is available for each condition by clicking on the link.

What’s in this section?

Signs and Symptoms

Symptoms of hemorrhagic stroke usually begin suddenly. The onset and course of symptoms are often different for an ICH or SAH. Symptoms may include:

  • Headache, usually of sudden onset with either an explosive onset or progressive course
  • Weakness, tingling or paralysis, typically on one side of the body
  • Difficulty swallowing
  • Confusion
  • Trouble with vision
  • Difficulty with balance
  • Trouble speaking and issues with reading, writing or understanding speech
  • Changes in alertness or consciousness


Diagnosis starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose, including: computed tomography () scan, magnetic resonance imaging () scan, CT angiography, or lumbar puncture/.

Treatment Options

Treatment options are based on several factors, including:

  • The type of hemorrhagic stroke and its cause
  • Symptoms
  • Presence of an underlying abnormality
  • Patient age and condition
  • The risk for further bleeding
  • The goals associated with treatment.

The medical, surgical and endovascular treatment of hemorrhagic stroke is continuously evolving, looking for ways to achieve better outcomes for the patient. The types of treatment and management of hemorrhagic stroke are dependent on its cause and may include:

  • Observation This is typically used for smaller or deep ICHs or non-aneurysm SAHs. Medical issues such as blood pressure management, salt balance and correction of bleeding issues are also addressed.
  • Open surgery (craniotomy) This option is typically considered for removal of a large, life-threatening ICH or treatment of an underlying cause such as a ruptured aneurysm, AVM or tumor.
  • Embolization (neuro) This may be used in selected circumstances to treat an underlying cause for ICH or SAH. This typically involves treatment of an aneurysm (coiling/stenting or flow diversion) or AVM.
  • Minimally invasive craniotomy In some circumstances, this may be considered for evacuation (removal) of an ICH located deep in the brain.
  • Decompressive craniectomy This surgery may be considered to reduce pressure related to an ICH or brain swelling from SAH due to aneurysm.
  • Ventriculostomy This is most often used to decrease pressure related to an intraventricular hemorrhage or hydrocephalus due to SAH. Sometimes, medications may be injected through the external ventricular drain to help dissolve clot filling the ventricle. It may also be used to monitor .
  • ICP Monitor This device may be used occasionally, but generally is not routinely used in the management of hemorrhagic stroke.

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