From the Guidelines
Hemorrhagic stroke is a medical emergency that presents with sudden onset of severe headache, nausea, vomiting, altered consciousness, difficulty speaking, vision problems, weakness, numbness, loss of balance, and seizures, requiring immediate medical attention to reduce morbidity and mortality. The signs and symptoms associated with hemorrhagic stroke are distinct and require prompt recognition to improve outcomes. According to 1, the classic clinical presentation includes the onset of a sudden focal neurological deficit while the patient is active, which progresses over minutes to hours.
Key Symptoms
- Sudden, severe headache
- Nausea and vomiting
- Altered consciousness, ranging from confusion to coma
- Difficulty speaking or understanding speech
- Vision problems
- Weakness or numbness on one side of the body
- Loss of balance or coordination
- Seizures These symptoms occur because bleeding in the brain creates pressure on brain tissue, disrupting normal function and potentially causing permanent damage. As noted in 1, blood irritates brain tissues, causing swelling and inflammation that further compromises neurological function.
Risk Factors
- Hypertension
- Anticoagulant use
- Cerebral aneurysms
- Arteriovenous malformations It is essential to identify prognostic indicators during the first several hours after stroke onset, as the volume of ICH and grade on the Glasgow Coma Scale (GCS) on admission are the most powerful predictors of death by 30 days, as stated in 1. Prompt medical attention is crucial to improve outcomes and reduce the risk of permanent disability or death.
From the Research
Signs and Symptoms of Hemorrhagic Stroke
The signs and symptoms associated with hemorrhagic stroke can vary, but some common presentations include:
- Sudden onset of focal neurologic deficits, such as weakness on one half of the body or difficulty with speech 2, 3
- Severe headache, which is a common presenting symptom of subarachnoid hemorrhage 2, 3
- Abrupt onset of symptoms, such as speech disturbance or weakness on one-half of the body 2, 3
- Neurologic deficits, such as difficulty with speech, weakness, or numbness, which can be caused by the hemorrhage 4
Diagnosis and Recognition
Diagnosis of hemorrhagic stroke requires neuroimaging, such as computed tomography (CT) scans, to differentiate it from ischemic stroke and other conditions 2, 3. Recognition of hemorrhagic stroke by emergency medical services (EMS) is critical for rapid identification and treatment, and is associated with higher quality of EMS care and faster CT scans upon emergency department arrival 5.
Clinical Features
Hemorrhagic stroke can be caused by a range of factors, including hypertension, cerebral amyloid angiopathy, and arteriolosclerosis 4. The clinical features of hemorrhagic stroke can vary depending on the location and size of the hemorrhage, as well as the underlying cause 4.
Management and Treatment
Management of hemorrhagic stroke typically involves controlling blood pressure and preventing further bleeding, as well as treating any underlying conditions that may have contributed to the hemorrhage 6. Medications such as labetalol may be used to lower blood pressure in patients with hemorrhagic stroke, and have been shown to be safe and effective in critically ill patients 6.