Hemorrhagic Stroke (Brain Hemorrhage)
Hemorrhagic stroke is a sudden, life-threatening neurological emergency caused by spontaneous bleeding into the brain tissue (intracerebral hemorrhage). It accounts for about 10-20% of all strokes; the most common cause is uncontrolled high blood pressure.
آخرین بهروزرسانی: 2026-06-07
Definition
Hemorrhagic stroke (intracerebral hemorrhage) occurs when a brain blood vessel ruptures and bleeds into the brain tissue. It is less common than ischemic stroke but often more severe; the resulting hematoma (collection of blood) compresses surrounding tissue and, with edema and rising intracranial pressure, impairs brain function. It is distinct from subarachnoid hemorrhage caused by aneurysm rupture.
Causes and Risk Factors
The most common cause is chronic hypertension, which weakens small vessels in typical regions such as the basal ganglia, thalamus, pons and cerebellum, leading to bleeding. In older patients, cerebral amyloid angiopathy (lobar hemorrhages near the brain surface), use of blood thinners (anticoagulants), vascular malformations (AVM, cavernoma), tumors and clotting disorders are other causes. In younger patients vascular malformations are more prominent.
Symptoms
Symptoms begin suddenly; unlike ischemic stroke, headache, nausea/vomiting and altered consciousness are more frequent. Depending on the site of bleeding, there may be one-sided weakness, sensory loss, speech disturbance, visual field loss, imbalance and seizures. Rapid worsening of consciousness, one-sided pupil enlargement or irregular breathing are emergency signs of raised intracranial pressure.
Diagnosis
Non-contrast brain computed tomography (CT) is the gold standard for emergency diagnosis; within seconds it shows the location and size of the bleed, midline shift and whether blood has extended into the ventricles. MRI helps assess the age of the hemorrhage and old microbleeds. In younger patients or atypical locations, CT/MR angiography and, when needed, digital subtraction angiography (DSA) are performed to look for an underlying vascular cause.
Treatment
Treatment is delivered in intensive care. In the early hours, priorities are controlled blood-pressure lowering to limit hematoma growth and, in anticoagulant-related bleeds, correction of clotting. Intracranial pressure is managed, and cerebrospinal fluid may be drained (external ventricular drainage) when needed. Surgery (hematoma evacuation) can be life-saving in selected cases, especially cerebellar hemorrhage or large superficial lobar bleeds; it is not appropriate for every patient.
Prognosis
Hemorrhagic stroke carries higher mortality than ischemic stroke; the outcome relates to the size and location of the hematoma, level of consciousness, ventricular extension, patient age and complications. Survivors may have persistent neurological impairment, and rehabilitation is important. The risk of rebleeding depends on the underlying cause and is reduced by controlling risk factors. Outcomes differ by patient and cannot be guaranteed.
منابع
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1608-1617.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:3563-3572.
- Greenberg SM, et al. Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage. Stroke (AHA/ASA). 2022.
- Mendelow AD, et al. Early Surgery versus Conservative Treatment in Intracerebral Haematomas (STICH). Lancet. 2005.
این مقاله صرفاً جنبه اطلاعرسانی عمومی دارد و جایگزین معاینه پزشک نیست. تصمیمات تشخیص و درمان فردی هستند.