Strokes killed over 800 people in Singapore in 2021 alone. There are two main kinds of stroke. A hemorrhagic stroke is when a blood vessel ruptures, while in ischemic stroke is when a blood vessel in the vein is blocked by plaque or a clot.
Overview of Hemorrhagic Stroke
Have you or a loved one recently been diagnosed with a stroke? Strokes can be a scary health event due to their potential to cause serious and sometimes life-threatening health outcomes. They occur when the blood supply to the brain is disrupted, leading to damage or death of brain cells. Strokes can cause a sudden onset of various symptoms, such as weakness or numbness in one side of the body, trouble speaking or understanding speech, severe headaches, dizziness, or loss of balance. Hemorrhagic stroke causes are varied and must be evaluated by medical professionals so that you can prevent them in the future.
There are two different major types of strokes, categorized based on their underlying causes:
- Ischemic Stroke: This is the most common type, accounting for about 87% of all strokes. It occurs when a blood clot blocks or plugs an artery, restricting blood flow to the brain.
- Hemorrhagic Stroke: These happen when a blood vessel in the brain ruptures or leaks, causing bleeding into the brain tissue. It accounts for about 13% of all strokes. Read more about the different types of stroke in our other blog post.
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Common Questions About Hemorrhagic Stroke (Brain Bleed)
What is a hemorrhagic stroke?
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures and causes bleeding within or around the brain.
Unlike an ischaemic stroke, which happens when a blood clot blocks blood flow, a hemorrhagic stroke occurs because bleeding damages brain tissue and increases pressure inside the skull.
The two main types of hemorrhagic stroke are:
Intracerebral haemorrhage (ICH)
Bleeding occurs directly within the brain tissue.
Subarachnoid haemorrhage (SAH)
Bleeding occurs in the space surrounding the brain, often associated with a ruptured brain aneurysm.
Both types require urgent medical assessment because bleeding can affect important areas of the brain.
What causes a hemorrhagic stroke?
Several conditions can increase the risk of bleeding in the brain.
Common causes and risk factors include:
- Long-standing high blood pressure
- Brain aneurysms
- Abnormal blood vessels such as arteriovenous malformations (AVMs)
- Blood-thinning medications
- Head injuries
- Certain blood vessel disorders
Identifying the underlying cause is important because treatment and prevention strategies depend on why the bleeding occurred.
What are the symptoms of a hemorrhagic stroke?
Symptoms of hemorrhagic stroke often occur suddenly and may include:
- Sudden severe headache
- Weakness or numbness on one side of the body
- Facial drooping
- Difficulty speaking or understanding speech
- Loss of coordination or balance
- Vision changes
- Confusion
- Seizures
- Loss of consciousness
A sudden severe headache, sometimes described as the “worst headache of life”, may occur with certain types of brain bleeding, such as subarachnoid haemorrhage.
Emergency medical attention is required if stroke symptoms appear.
How is hemorrhagic stroke diagnosed?
Doctors use imaging and specialist assessment to determine whether bleeding has occurred and identify the cause.
Diagnostic tests may include:
CT brain scan
Often used urgently to detect bleeding in the brain.
MRI brain scan
May provide additional information about brain injury and blood vessel changes.
CT angiography (CTA) or MR angiography (MRA)
May help assess blood vessels and identify abnormalities.
Cerebral angiogram
A detailed blood vessel study that may be required when doctors need precise information about aneurysms, AVMs or other vascular conditions.
Understanding the cause of bleeding helps guide treatment decisions.
What treatments are available for hemorrhagic stroke?
Treatment depends on:
- The location and size of the bleeding
- The cause of the stroke
- The patient’s overall health
- The effect on surrounding brain tissue
Treatment may include:
Medical management
This may involve:
- Controlling blood pressure
- Managing brain swelling
- Adjusting blood-thinning medications where necessary
- Monitoring neurological changes
Minimally invasive neurointerventional treatment
For certain causes, catheter-based procedures may be considered, such as:
- Treating ruptured brain aneurysms
- Managing abnormal blood vessels
- Preventing further bleeding risk
Surgery
Some patients may require surgical treatment depending on the location and severity of bleeding.
A specialist assessment helps determine the most appropriate approach.
Hemorrhagic Stroke (Bleeds)
A hemorrhagic stroke occurs when a blood vessel in the brain bursts and causes bleeding. Imagine that the blood vessels in your brain are like pipes carrying blood. If one of those pipes suddenly breaks and starts leaking, it can lead to a hemorrhagic stroke. This can be quite dangerous because the leaked blood can cause pressure in the brain. The damage is like water leaking from a broken pipe, damaging the surrounding area. A hemorrhagic stroke is when a blood vessel in the brain bursts and causes bleeding, which can be harmful to the brain.
There are two subtypes of hemorrhagic stroke: intracerebral hemorrhage and subarachnoid hemorrhage. Intracerebral hemorrhage refers to bleeding within the brain tissues. A subarachnoid hemorrhage occurs when blood leaks into the space between the brain and the surrounding tissues. Strokes can result in severe neurological issues. They also have a higher mortality rate compared to ischemic strokes, which is why it is so important to seek treatment immediately if you notice the signs. Diagnosing the cause and symptoms is the first step doctors will take. Then, they can decide on treatment.
Symptoms of Hemorrhagic Stroke
Hemorrhagic stroke symptoms can be varied and include:
- Sudden and severe headache: A person may experience a sudden, extreme headache different from any they have experienced before. Often, they describe it as "the worst headache ever." If asked to evaluate, they often say the pain is ten out of ten.
- Nausea and vomiting: The person may feel nauseous and vomit due to the intense headache. Sometimes, this is mistaken as a migraine. The pain level can help determine if the headache and nausea are abnormal.
- Weakness or numbness: They may feel weak or numb on one side of their body or face. For example, their arm may look limp or experience sagging on one side of the face.
- Difficulty speaking or understanding: A stroke victim may have trouble speaking, slurred speech, or understanding what others say. Some people will have aphasia, where they speak what sounds like "gibberish," but it makes sense to them.
- Loss of balance and coordination: They might experience sudden dizziness or have trouble walking. This can sometimes be mistaken as intoxication.
- Vision problems: They may experience blurred or double vision, or their eyesight may become impaired.
It's important to note that if someone experiences hemorrhagic stroke symptoms, they should seek immediate medical attention. Getting medical care as soon as possible can help minimize brain damage. Call 9-9-5 or get to the nearest emergency room immediately if you or a loved one are experiencing the below stroke warning signs.
Hemorrhagic Stroke Causes
Hemorrhagic stroke can be caused by ruptured aneurysms, bleeding from arteriovenous malformations, high blood pressure, and underlying medical conditions that affect blood clotting or vessel health. A specialized hemorrhagic stroke clinic in Singapore will work to find the cause of a stroke and how to prevent it in the future.
Aneurysms, weakened areas in blood vessel walls, can burst and cause bleeding. Brain Arteriovenous malformations (AVMs), which are abnormal tangles of blood vessels, can rupture and bleed as well. Read more about the difference between AVM and brain aneurysm in our other informative article. High blood pressure is a major cause of hemorrhagic stroke. When left uncontrolled, high blood pressure can weaken blood vessel walls, making them more prone to rupture. Other diseases can cause a stroke as well. For example, blood clotting disorders and liver disease can increase the risk of strokes and should be adequately treated. Autoimmune diseases like lupus can also cause strokes.
Diagnosis of Hemorrhagic Stroke
Hemorrhagic stroke diagnosis takes place using a combination of medical history evaluation, physical examination, and imaging tests. Hemorrhagic stroke treatment in Singapore is no different; a doctor will work closely with you to review your medical history, looking for risk factors such as high blood pressure, smoking, diabetes, or a family history of stroke. They will then perform a physical examination to assess neurological symptoms such as weakness, numbness, or difficulty speaking, which all are symptoms.
Imaging tests are used to confirm the diagnosis of a hemorrhagic stroke. Computed tomography (CT) scans and magnetic resonance imaging (MRI) are the most commonly used tests. CT scans can quickly detect bleeding in the brain. MRIs can pick up subtle imaging that CTs cannot. Occasionally, a cerebrospinal fluid (CSF) analysis may be performed to confirm a diagnosis.
Once diagnosed, we will work to manage any associated complications and determine the underlying cause of the bleed.
The treatment and management of strokes depend on various factors. Doctors evaluate the location and severity of the bleed, the patient's overall health, and the underlying cause. The primary goals of treatment are to stop the bleeding, reduce pressure on the brain, prevent complications, and support the patient's recovery. Patients will often show small signs of improvement while still in the hospital. Watching the patients is a good way for doctors to evaluate them and help plan their treatment.
When to Consider a Stroke Specialist Assessment
A hemorrhagic stroke requires careful evaluation to understand why bleeding occurred and how future risks can be reduced.
Consider arranging a specialist assessment if you:
- Have experienced a hemorrhagic stroke or brain bleed.
- Have been diagnosed with bleeding caused by a brain aneurysm or abnormal blood vessel.
- Want to understand the cause of your stroke.
- Need further assessment of brain or blood vessel imaging.
- Have concerns about preventing another stroke.
- Want a second opinion about treatment options.
- Have ongoing symptoms after stroke, including weakness, balance problems or difficulty with daily activities.
At the Supreme Vascular and Interventional Clinic, stroke assessment focuses on identifying the underlying cause of bleeding, reviewing brain and vascular imaging, and helping patients understand available treatment options.
Your specialist will guide you through diagnosis, treatment planning and long-term follow-up, with a focus on personalised care and reducing future stroke risk.
Seek emergency medical attention immediately if you experience:
- Sudden severe headache
- Loss of consciousness
- New weakness or numbness
- Difficulty speaking
- Seizures
- Sudden vision changes
- Sudden loss of balance
These may be signs of a serious neurological emergency.
Hemorrhagic Stroke Treatment Options and Management in Singapore
Hemorrhagic stroke treatment in Singapore is patient-centered, focusing on healing and prevention. General supportive care includes maintaining stable vital signs, providing oxygen therapy, and monitoring the patient's neurological status closely. Medications may be administered to control blood pressure, prevent seizures, and alleviate pain or discomfort. Not all hemorrhagic strokes require surgical intervention. The decision for surgery depends on factors such as the size, location, and stability of the aneurysm, as well as the patient's overall health.
Stroke Treatment Options
- Aneurysm Clipping: This procedure is performed if a ruptured cerebral aneurysm causes the hemorrhage. It involves surgery that places a small metal clip at the aneurysm's base to prevent further bleeding.
- Endovascular Coiling: Also known as endovascular embolization, this minimally invasive invasive procedure involves inserting a catheter through the groin and navigating it to the aneurysm site. Tiny platinum coils are then threaded through the catheter, causing it to clot.
- Stent-Assisted Coiling: This procedure combines stents and endovascular coiling. A stent is placed across the neck of the aneurysm to provide additional support and prevent coil migration.
- Clot Removal: In some cases, surgery can help remove a clot or relieve pressure on the brain caused by the bleed.
A hemorrhagic stroke specialist in Singapore will work with each patient individually to educate them and help explore their options. After treatment or surgery, rehabilitation is the next phase. It can help restore a patient's quality of life. Physical, occupational, and speech therapy may be necessary to help patients regain mobility and function, overcome communication difficulties, and begin to reclaim their lives. Have you or a loved one experienced a stroke or stroke-like symptoms? We're here to help diagnose and formulate a plan for wellness. Get in touch today to learn more about your options and how we can help you get the best outcome possible.
The Supreme Vascular and Interventional Clinic's Comprehensive Stroke Treatments in Singapore
The Supreme Vascular and Interventional Clinic provides a full spectrum of neurointerventional treatments that seek to deal with stroke-related issues. There are personalized treatment plans for stroke to improve your quality of life. Contact us today to see how we can help you on your stroke journey with our programs including stroke screening, management, and prevention.
Read More About Neurointerventional Treatments on Our Blog
To dive deeper into the types of neurointerventional treatments, head over to our clinic’s blog.
Read our recommended neurointerventional treatments related blog posts to stay informed. What is a stroke? Watch our helpful video to learn stroke causes, symptoms, diagnosis, treatment, and more.
- Stroke Prevention: Causes and Risk Factors
- Stroke Causes, Symptoms, Diagnosis, and Treatment: A Complete Guide
- Types of Stroke: Ischaemic, Haemorrhagic, and TIAS
- Headaches: What It is, Types, Causes, Symptoms, And Treatment
- Brain Aneurysm Q&A with Dr. Manish Taneja
- 10 Brain Aneurysm Questions Answered
- The Ultimate Guide to Brain Aneurysm
- Conversation with Dr. Manish Taneja on Brain Aneurysm Advances and Care
- The Dangers of Brain Aneurysm
- Brain Aneurysm: Best Minimally Invasive Treatments
- Brain AVM (Arteriovenous Malformation)
Stroke Resources
Stroke Prevention Tips: How to Avoid High Cholesterol
Controllable risk factors are lifestyle choices that can be changed to reduce the risk of having a stroke including managing your cholesterol.
We've Got You Covered for Specialized Stroke Screening, Prevention, and Management
Imagine heart attacks where the blood flow to your heart is blocked. Similarly, a stroke occurs when the blood flow to your brain is interrupted becoming a "brain attack". When blood supply does not reach a certain part, brain cells begin to die. Different types of stroke include ischemic strokes (blockage of blood vessel due to blood clot) or a mini stroke, a TIA (transient ischemic attack), with no permanent damage yet serious. Stroke also occurs when a blood vessel in the brain pops causing bleeding in the brain.
When a stroke occurs, the symptoms of stroke depend on how blood flow to the brain is affected. Individuals at high risk and even higher risk (family history) often have high blood pressure, atrial fibrillation, or another risk factor for stroke, all of which increase the risk of stroke. Disrupted blood flow can even damage the blood vessel in the brain and affect one side of the body. Having a stroke doesn’t mean it has to lead to permanent disabilities. Recognizing early warning signs is essential to reduce the risk, and in some cases, procedures such as carotid endarterectomy may help increase the blood vessel in the brain and restore healthy circulation.
Certain areas of the brain can be affected by stroke and some symptoms of a stroke including cardiovascular disease, diabetes, and high blood sugar levels increase the risk of stroke whereas an active lifestyle or controlling high cholesterol reduces the risk. How well do you know stroke? Find tips to prevent and manage stroke, the differences in stroke screening tests, and the newer technology and treatments available. Come in for an easy consultation and further evaluation with our stroke specialist in Singapore at the Supreme Vascular and Interventional Clinic.
Supreme Vascular and Interventional Stroke Programs
Neurointerventional / Stroke Treatments
The Supreme Vascular and Interventional Clinic is your "go-to" facility for various neurointerventional / stroke conditions and treatments. To arrange an appointment with Dr. Manish Taneja, our neurointervention specialist, contact us. You can also call us at (+65) 6904 8084 for a consultation.