At a glance
What it is
A stroke caused by rupture of a blood vessel supplying the brain, causing bleeding that deprives brain cells of oxygen and raises intracranial pressure through mass effect. Two main types: intracerebral haemorrhage (bleeding within brain tissue, usually from hypertension) and subarachnoid haemorrhage (bleeding in the space surrounding the brain, usually from a ruptured aneurysm or AVM). Accounts for ~13% of all strokes but causes disproportionately high mortality and disability.
Symptoms
Sudden severe ('thunderclap') headache — worst of life — is classic for subarachnoid haemorrhage. Both types may cause: sudden focal weakness, speech difficulty, or visual loss; altered consciousness; nausea and vomiting; neck stiffness (SAH). Intracerebral haemorrhage often progresses over minutes to hours as the haematoma expands. Any sudden neurological deficit requires emergency assessment.
Approach
Urgent CT brain to confirm haemorrhage type and assess for treatable causes. Medical stabilisation: blood pressure control, reversal of anticoagulation, ICP management. Surgical evacuation of haematoma or treatment of the underlying cause (aneurysm clipping or coiling; AVM resection) based on haemorrhage type, location, size, and patient status. Post-acute rehabilitation is essential to maximise recovery of function.
What a haemorrhagic stroke is
A haemorrhagic stroke occurs when a blood vessel in or around the brain ruptures, allowing blood to escape into the surrounding tissues or fluid-filled spaces. Unlike ischaemic stroke — where a clot blocks blood flow — haemorrhagic stroke causes injury through two mechanisms: direct loss of perfusion to brain tissue, and rising intracranial pressure as the haematoma expands and compresses surrounding structures.
**Types of haemorrhagic stroke**
*Intracerebral haemorrhage (ICH)* — bleeding within the brain parenchyma itself, accounting for approximately 10% of all strokes. The most common cause is chronic hypertension, which weakens the walls of small penetrating arteries over time. Bleeding occurs suddenly and may continue to expand for several hours. The haematoma acts as a space-occupying lesion, compressing adjacent brain tissue and raising ICP. Other causes include cerebral amyloid angiopathy (in elderly patients), coagulopathy, and haemorrhagic transformation of an ischaemic infarct.
*Subarachnoid haemorrhage (SAH)* — bleeding into the subarachnoid space between the brain and its innermost covering (the pia-arachnoid), accounting for approximately 3% of strokes. The classic presentation is a sudden, severe 'thunderclap' headache — the worst headache of the patient's life — often with nausea, vomiting, photophobia, and neck stiffness. The most common cause is rupture of an intracranial aneurysm; arteriovenous malformations (AVMs) are another important cause.
*Aneurysm* — a focal, balloon-like weakening of an arterial wall. May be congenital or develop due to hypertension or atherosclerosis. Aneurysm rupture carries a high mortality; survivors face a significant risk of re-bleeding within the first days and delayed cerebral ischaemia from vasospasm.
*AVM (arteriovenous malformation)* — a congenital tangle of abnormal arterial-venous connections that bypasses the normal capillary bed. The high-pressure arterial flow is transmitted directly to thin-walled veins, which may rupture.
**Emergency management**
- Stabilise airway, breathing, and circulation - Urgent non-contrast CT brain to confirm haemorrhage and distinguish from ischaemic stroke - CT angiography to identify underlying aneurysm or AVM - Blood pressure control (aggressive lowering reduces haematoma expansion in ICH) - Reverse anticoagulation immediately - Manage raised intracranial pressure: head elevation, analgesia/sedation, osmotherapy, and where necessary external ventricular drainage
**Surgical treatment**
- *Craniotomy and haematoma evacuation:* performed in selected ICH patients where the clot is accessible and causing significant mass effect or neurological decline - *Aneurysm clipping:* open surgical ligation of the aneurysm neck to prevent re-bleeding - *Endovascular coiling:* catheter-based placement of platinum coils inside the aneurysm to promote thrombosis — the preferred approach for most aneurysms - *AVM resection or embolisation:* surgical excision or interventional radiology to eliminate the nidus of the AVM
**Rehabilitation**
After medical and surgical stabilisation, structured neurorehabilitation — physiotherapy, occupational therapy, speech therapy, and neuromodulation — is essential to maximise recovery of motor, cognitive, and communication function.
Treatment options at Alimran Medical Center
Injection therapies
Advanced therapies
Physiotherapy & rehabilitation
- Electrical stimulation
- Short and long wave therapy
- Laser therapy
- Ultrasound therapy
- Neurological rehabilitation and strength training
- Sigma
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about haemorrhagic stroke and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.