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Hypertension & Stroke


Hemorrhagic Stroke


Stiff neck.

Sudden, excruciating headache.

Nausea and vomiting.

Mental confusion.

Sudden loss of consciousness without warning.

Paralysis on one side of the face or body.

Speech difficulty or loss of ability to speak.

Blurred or double vision, dilated pupils, crossed eyes, or inability to move the eyes.

When To Call Your Doctor

Call an ambulance immediately if you or someone in your presence exhibits symptoms of a hemorrhagic stroke.

What Is It?

A hemorrhagic stroke is one of the two main types of strokes. It results when a ruptured artery causes bleeding into the brain (intracerebral hemorrhage) or into the space between the membranes surrounding the brain (subarachnoid hemorrhage).

Damage occurs in two ways. First, blood supply is cut off to the parts of the brain beyond the site of the rupture in the artery. Second—and more dangerous—the escaped blood forms a mass that increases pressure on the surrounding brain tissue. Blood continues to flow until it coagulates or until it simply has no place left to go. Intracerebral bleeds usually occur in the cerebrum, the part of the brain that controls higher functions such as speaking and reasoning. Subarachnoid hemorrhages usually occur at the base of the brain. Massive hemorrhages are usually fatal; only about 25 percent of patients survive.

What Causes It?

High blood pressure is the main cause.

Atherosclerosis (the buildup of fatty plaque in the arteries) weakens arterial walls, further increasing the risk of hemorrhage due to hypertension.

Bleeding disorders (such as hemophilia and leukemia) and the use of anticoagulant or thrombolytic drugs increase the risk of intracerebral bleeding.

Aneurysms (weak spots in the wall of an artery that may burst) are a major cause of subarachnoid hemorrhage. They are often due to congenital defects (defects present at birth).

Blood vessel abnormalities such as arteriovenous malformation (AVM) may result in a stroke.

A head injury may rupture arteries in the brain.

Brain tumors may lead to intracerebral bleeding.


Keep blood pressure and weight under control.

People with undiagnosed aneurysms will often have severe, sudden, unusual headaches initially. If the cause of these can be identified, arteriography (diagnostic imaging of the arteries) may reveal a surgically treatable aneurysm.


Arteriography may be used to detect cerebral aneurysms before they rupture.

A lumbar puncture (spinal tap) may be used to test for blood in the cerebrospinal fluid and to check for increased pressure within the skull.

CT (computed tomography) scans of the head may be taken to identify and assess the amount of hemorrhaging in the brain.

MRI (magnetic resonance imaging) can detect abnormal blood vessels, underlying tumors, and some aneurysms.

How To Treat It

Call an ambulance immediately.

After careful evaluation, physicians may take emergency measures to reduce blood pressure to minimize the flow of blood from the ruptured artery.

Life support may be necessary.

Surgical repair, if attempted at all, is usually delayed for one to two weeks after the incident, although another approach calls for more rapid surgical intervention in some cases.


From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.


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Hypertension & Stroke

The Hypertension & Stroke White Paper from The Johns Hopkins White Papers series is an annual, in-depth report written by Hopkins physicians.

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