Hemorrhagic stroke (cerebral hemorrhage) – can occur when a vessel is ruptured in people suffering from essential hypertension and atherosclerosis, hemorrhagic diathesis, single and multiple cerebral aneurysms caused by congenital arterial inferiority, head trauma, coarctation of aortic stenosis (pronounced sclerotic subsequent formation of aneurysms), septic endocarditis (specific arteritis leads to mycotic aneurysms with their subsequent rupture).

There are intracerebral hemorrhage of primary and secondary etiology: 

  • primary spontaneous intracerebral hemorrhage is defined as hemorrhage in the absence of vascular pathologies or associated diseases; 
  • secondary intracerebral hemorrhage occurs against the background of identified vascular pathology or is a complication of other diseases of internal organs or neurological diseases in which either coagulation disorders or vessel rupture are observed.

The clinical picture of hemorrhagic stroke

Hemorrhagic stroke in 60-75% of cases leads to the death of patients. It is characterized by: 

  • The lightning-fast development of the disease with loss of consciousness and a rapid transition to a coma. 
  • The breathing of patients becomes hoarse, vomiting appears. The skin of the face becomes purple-bluish, the body temperature rises. 
  • The pupil on the side of the hemispheric hemorrhage expands significantly, the reaction to light disappears, “floating” or pendulum-like movements of the eyeballs appear. 
  • On the side opposite to the hemorrhage, hemiplegia is found with an increase (or decrease) in tendon and periosteal reflexes in the first hours of the disease. Incontinence of urine and feces is observed. 

Focal symptoms depend on the extent and location of the hematoma, especially since nystagmus, a disorder of cardiovascular activity and respiration, appears as the brain stem is compressed. 

Intraventricular hemorrhage (IVH). A severe complication of hemorrhagic stroke is bleeding into the ventricles of the brain, which is accompanied by the appearance of tonic convulsions, mainly in the flexors of the upper extremities and extensors of the lower extremities (hormetonia, decerebrate rigidity), arising spontaneously or under the influence of strong external stimuli (painful skin pricks, bright light, strong sound). 

Cerebellar hemorrhage is manifested by dizziness, sharp pain in the occiput and muscles of the shoulder girdle, nausea, vomiting, hypotension, and impaired coordination. As the condition worsens, a different position of the eyeballs in the vertical plane is noted (Hertwig-Magendie symptom), meningeal symptoms, nystagmus, impaired respiration, and cardiac activity. 

Subarachnoid hemorrhage often occurs as a result of rupture of aneurysms localized in the arterial circle of the large brain (circle of Willis), especially in young people. After short precursors in the form of headache, tinnitus, a sharp headache appears, often with psychomotor agitation, vomiting, sometimes damage to the cranial nerves, stiff neck muscles, bilateral Kernig’s symptom, photophobia, and sometimes epileptiform syndrome join. 

Types of hemorrhagic stroke

  • Non-traumatic subarachnoid hemorrhage is less common, but this type of stroke is the most dangerous – almost 50% of cases are fatal. And even with early diagnosis and timely adequate treatment, a person is more likely to remain severely disabled for the rest of his life. The main symptom is a sharp headache of the “blow to the head” type, often with pulsation in the occipital region, there are also vomiting, convulsions, violation of consciousness.
  • Hemorrhagic stroke, or cerebral hemorrhage, is fatal in 40% of cases. Symptoms – fever, headache, blurred vision – may not even be noticed in time. The stroke develops quickly, usually during the daytime. Its reasons can be both banal overstrain and hypertension, atherosclerosis and other cardiovascular diseases, and at a young age – cocaine addiction.

What happens after a stroke?

Usually, the prognosis is poor, as brain damage often leads to death. This is because cerebral edema gradually progresses. Sometimes death occurs due to another hemorrhage in another part of the brain. Even if the patient survives, the consequences of a hemorrhagic stroke lead him to a disability, since full health restoration is almost impossible. Rehabilitation takes a lot of time and effort from the patient and his relatives. But sometimes the restoration of health is still possible, albeit partial. Rehabilitation is carried out with the participation of doctors, exercise therapy instructors, and nurses. There is no point in hoping for a quick recovery because rehabilitation can take months, and sometimes years. Rehabilitation is usually carried out in specialized departments of hospitals and sanatoriums, where experienced doctors monitor the progress of the patient’s recovery.