Brain Haemorrhagic Stroke Explained: When Every Second Counts

A haemorrhagic stroke is one of the most serious types of stroke. Seeing my loved one survive a stroke showed me the power of early diagnosis. It inspired me to focus on timely detection and preventive care. Despite improvements in blood pressure control, haemorrhagic strokes continue to rise worldwide.¹

According to the Global Burden of Disease 2023 study, stroke remains the second leading cause of death worldwide.² Each year, it affects about 13.7 million people and causes nearly 5.5 million deaths. Most cases are first-time strokes, while only 10–25% are repeat events. About 87% of strokes are ischemic, occurring when a blood vessel supplying the brain becomes blocked.³ The remaining strokes are haemorrhagic, often referred to as “brain bleeds,” which occur when a weakened blood vessel bursts and bleeds inside the brain.^3,4

In response, researchers are pushing for faster diagnosis, safer surgical techniques, and better ways to protect the brain. These advances offer hope for improved recovery and survival. In the end, every second matters during a stroke.

Stroke Explained: Ischemic and Haemorrhagic Types

A stroke, often called a “brain attack,” happens when blood flow to part of the brain suddenly stops. It occurs when a blood vessel becomes blocked or bursts, cutting off oxygen and nutrients. Within minutes, brain cells start to die. As a result, speech, movement, or memory can be affected. The impact depends on where the stroke occurs and how much brain tissue is damaged.⁵

There are two main types of strokes: ischemic and haemorrhagic.

An ischemic stroke occurs when a blood clot blocks an artery in the brain, stopping normal blood flow. It can happen in two ways:

• Thrombotic stroke: A clot forms inside a brain artery.
• Embolic stroke: A clot travels from another part of the body to the brain.⁵

However, a haemorrhagic stroke happens when a weak blood vessel bursts. This leads to bleeding inside or around the brain. The bleed blocks normal blood flow and increases pressure in the skull. As a result, brain tissue suffers damage. The main causes are high blood pressure and aneurysms. An aneurysm is a weak spot in a blood vessel that can rupture easily.  In addition, head injuries, blood-thinning drugs, and vessel defects can also trigger this type of stroke.⁵

Bleeding can occur either inside or outside the brain tissue:

·     Outside the brain:

• An epidural bleed occurs between the skull and the dura mater.
• A subdural bleed forms between the dura and arachnoid layers.
• The subarachnoid bleed happens between the arachnoid and pia mater, usually due to a ruptured aneurysm.

·     Inside the brain:

• Intracerebral haemorrhage: bleeding within the brain tissue, often caused by long-term high blood pressure.
• Intraventricular haemorrhage: occurs when bleeding enters the brain’s ventricles. These spaces produce cerebrospinal fluid, which protects and supports the brain.⁴

Recognizing the Key Difference

Understanding the difference between haemorrhagic and ischemic strokes helps ensure quick treatment. A haemorrhagic stroke appears suddenly. It causes a severe headache, vomiting, and a sharp rise in blood pressure. Soon after, weakness or confusion may follow. In contrast, an ischemic stroke develops more slowly. It can cause slurred speech, paralysis, or loss of coordination, depending on the brain area affected.^6,7

 The “Act FAST” campaign teaches people to spot stroke signs and call for help quickly. It started in the UK in 2009 and later spread to the USA and Australia. Since then, it has improved how fast strokes are diagnosed and treated.⁸

The FAST acronym stands for:

• F – Face: Look for drooping or an uneven smile.
• A – Arm: Check for weakness or numbness.
• S – Speech: Listen for slurred or unusual speech.
• T – Time: Every second counts—call emergency services immediately.⁸

However, experts warn that sudden vision loss can also signal a stroke. It often occurs when the front or back parts of the brain’s circulation are affected. To address this, they created an updated version called “Act VFAST,” where ‘V’ stands for Vision. This update reinforces the message to act very fast.⁹

Haemorrhagic Stroke Diagnosis: Acting Fast to Save the Brain

Timely and accurate diagnosis of a haemorrhagic stroke is crucial for recovery. Doctors use clinical expertise and advanced imaging tools to identify bleeding and locate its source. This allows them to begin treatment within minutes, improving the chances of recovery.⁵

Neurological Examination: The First Step in Detection

Diagnosis begins with a neurological exam to assess brain function in a suspected haemorrhagic stroke. During this exam, doctors check awareness, speech, and memory. They also test vision, eye movement, and limb strength. In addition, they assess sensation, reflexes, balance, and coordination. Any abnormal finding may point to brain injury and guide further testing.

 Imaging Tests for Haemorrhagic Stroke Diagnosis

Imaging scans play a key role in confirming a haemorrhagic stroke. They help doctors see the size and location of the bleed. As a result, treatment can begin quickly and accurately.

• CT Scan: The first and fastest test, ideal for spotting active bleeding.
• MRI scans: These are used later to capture detailed images of brain tissue. They help doctors see the full extent of damage. Once the patient is stable, this step provides a clearer picture of recovery needs.

Cerebral Angiography and Blood Vessel Imaging

Doctors often perform cerebral angiography to find the source of bleeding. They inject a special dye into the bloodstream. X-ray images then show aneurysms, arteriovenous malformations (AVMs), or carotid artery narrowing. These are possible causes of a haemorrhagic stroke. Doctors also use a carotid duplex ultrasound. This simple test uses sound waves to check blood flow and detect plaque buildup in the neck arteries. If the artery is too narrow, surgery can help restore normal circulation.

Additional Diagnostic Procedures

If imaging results are unclear, doctors may perform a lumbar puncture (spinal tap). This test checks for blood in the cerebrospinal fluid and helps confirm internal bleeding.⁵

Haemorrhagic Stroke Treatment: Controlling Damage and Promoting Recovery

Treatment for a haemorrhagic stroke focuses on saving brain tissue and preventing further damage. First, doctors provide urgent care to control bleeding and reduce pressure in the brain. Then, they begin advanced therapies and rehabilitation to support healing and speed up recovery.The various treatment methods are outlined below.

 1. Acute Management 

Blood Pressure Control: Doctors act quickly to lower blood pressure gradually to about 150/90 mmHg. They use medicines such as labetalol or nicardipine to achieve this. Rapid control limits further bleeding and protects brain tissue.

Managing Brain Intracranial Pressure: Next, doctors work to reduce swelling and pressure inside the skull. They raise the patient’s head, give mannitol or hypertonic saline, or drain excess fluid through a catheter. These steps improve blood flow and prevent additional brain injury.

Stopping Bleeding (Hemostatic Therapy): To stop ongoing bleeding, doctors restore normal clotting. They administer vitamin K, fresh frozen plasma (FFP), or prothrombin complex concentrates (PCCs). This treatment is especially important for patients taking blood thinners.

Preventing Seizures: After a haemorrhagic stroke, some patients may develop seizures. In such cases, doctors prescribe antiepileptic drugs. However, routine use offers no proven long-term benefit.¹⁰

2. Advanced and Supportive Therapies

Surgery

In severe cases, surgery becomes the next step. Doctors remove blood clots and ease pressure on the brain. They use procedures such as craniotomy or decompressive craniectomy. As a result, surgery quickly relieves pressure and improves survival and recovery.

Neuroprotective Therapies

New investigational drugs such as citicoline, deferoxamine, and pioglitazone may help protect brain cells. Early studies suggest they can reduce oxidative stress and calm inflammation, which could potentially limit brain damage and support recovery. 

Rehabilitation

Early rehabilitation speeds recovery. It helps prevent complications such as infection or stiffness. Patients regain movement, speech, and balance through regular therapy. In addition, rehabilitation builds strength and confidence. As a result, early therapy improves long-term quality of life for stroke survivors.¹⁰

 

Stem Cell Therapy: The Future of Haemorrhagic Stroke Treatment

Current treatments for haemorrhagic stroke stop bleeding and lower pressure inside the skull. However, long-term recovery remains limited. Ongoing damage from inflammation, oxidative stress, and cell failure can worsen brain injury.

Stem cell therapy offers new hope. These cells lower inflammation and oxidative stress. In addition, they help repair damaged brain tissue. They can also restore lost function. As research advances, this therapy may improve recovery and long-term outcomes after a haemorrhagic stroke.¹¹

Conclusion

Every second counts in a haemorrhagic stroke. Acting fast can mean the difference between life and disability. The ‘Act VFAST’ rule helps people spot stroke signs early. It stands for Vision changes, Face drooping, Arm weakness, Speech difficulty, and Time to call emergency help.

Quick action leads to better outcomes. Specialized stroke units can diagnose and treat faster. These teams include experts in emergency care, neurology, and neurosurgery. After treatment, recovery continues with rehabilitation. Early therapy helps restore movement and speech. Cognitive exercises also support brain healing and improve quality of life.

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References

1. Jessica Magid-Bernstein, Romuald Girard, Sean Polster, Abhinav Srinath, Sharbel Romanos, Issam A Awad, Lauren H Sansing. Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions. Circ Res. 2022 Apr 14;130(8):1204–1229. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10032582/

2. Global Burden Of Disease 2023- https://www.healthdata.org/sites/default/files/2025-10/GBD_2023_Booklet_Final_2025.10.17.pdf

3. Diji Kuriakose, Zhicheng Xiao. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci. 2020 Oct 15;21(20):7609. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7589849/

4.Brain Bleed: When To Call for Help. Cleveland Clinic [Internet]. [cited 2026 Jan 6]. Available from: https://my.clevelandclinic.org/health/diseases/14480-brain-bleed-hemorrhage-intracranial-hemorrhage.

5. Miss.B.M.Gund, Mrs.P.N.Jagtap, Mr. V.B.Ingale, Dr.R.Y.Patil. Stroke: A Brain Attack. IOSR Journal Of Pharmacy (e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219. Available from: https://www.iosrphr.org/papers/v3i8/part.2/A038201023.pdf

6. Seyedhossein Ojaghihaghighi, Samad Shams Vahdati, Akram Mikaeilpour, Ali Ramouz . Comparison of neurological clinical manifestation in patients with hemorrhagic and ischemic stroke. World J Emerg Med. 2017;8(1):34–38. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5263033/

7. Marilyn M Rymer. Hemorrhagic Stroke: Intracerebral Hemorrhage. Mo Med. 2011 Jan-Feb;108(1):50–54. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6188453/

8. Zain A Bhutta, Sameer A Pathan, Tuukka Puolakka et. al. Assessing Stroke Awareness and Behavioural Response Following the National ‘Act Fast’ Stroke Awareness Campaign – Insights from a Cross-Sectional Survey in Qatar. J Patient Exp. 2024 Aug 5;11:23743735241242717. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11301737/

9. Mitchell Lawlor, Richard Perry, Gordon T Plant. Is the ‘Act FAST’ stroke campaign lobeist? The implications of including symptoms of occipital lobe and eye stroke in public education campaigns. https://doi.org/10.1136/jnnp-2014-308812. Available from: https://jnnp.bmj.com/content/86/7/818

10. Ajaya Kumar A. Unnithan; Joe M. Das; Parth Mehta. Hemorrhagic Stroke.StatPearls Publishing; 2025 Jan.Available from:https://www.ncbi.nlm.nih.gov/books/NBK559173/

11. Molly Monsour, Cesario V. Borlongan. Emerging regenerative medicine for hemorrhagic stroke: An update on stem cell therapies.Brain HemorrhagesVolume 4, Issue 1, March 2023, Pages 22-26. Available from:https://www.sciencedirect.com/science/article/pii/S2589238X22000389

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