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Hemorrhagic stroke involves bleeding within the brain, damaging nearby brain tissue
Alternative Names

Cerebral bleeding, cerebral hemorrhage, hemorrhagic stroke, bleeding in the brain
Causes and Risk Factors

Hemorrhagic stroke occurs when a blood vessel bursts inside the brain. The brain is very sensitive to bleeding and damage can occur very rapidly, either by the presence of the blood itself or because the fluid increases pressure on the brain and harms it by pressing it against the skull.

Bleeding irritates the brain tissues, causing swelling. The tissues surrounding the brain resist the expansion of the bleeding, which is finally contained by forming a mass (hematoma). Both swelling and hematoma will compress and displace normal brain tissue.

Hemorrhagic stroke is more often associated with high blood pressure, which stresses the artery walls until they break.

Another cause of stroke is an aneurysm. This refers to a weak spot in an artery wall, which balloons out because of the pressure of blood flowing through the affected artery. Finally, it can burst and cause a serious problem. The larger the aneurysm, the more likely it is to burst. It is unclear why people develop aneurysms, but genes may play a role, since aneurysms run in families.

Stroke can also be caused by the accumulation of a protein called amyloid within the artery walls, particularly in the elderly. This makes the arteries more prone to bleeding.

Amyloid protein is also involved in brain damage related to Alzheimer’s disease, but the difference is that people with Alzheimer’s disease have amyloid accumulation in brain tissue rather than the arteries. Therefore, people with Alzheimer’s disease generally do not develop brain bleeding.

Some people with brain hemorrhage have abnormal connections between arteries and veins. Under normal circumstances, circulating blood travels through the arteries into the capillaries, where it provides nutrients and oxygen to the tissues. Once the blood has deposited the nutrients and oxygen, is carried back to the heart from the capillaries via the veins.

However, in some people, a brain artery may connect directly to a vein instead of first going through the capillaries, which is called arteriovenous malformation (AVM). Since blood pressure in the arteries is much higher than in the veins, the veins may rupture, causing bleeding in the brain.

Another important brain disease that can cause bleeding is cancer. This is particularly true for cancers that spread to the brain from distant organs such as breast, skin and thyroid.

About 20% of strokes are hemorrhagic, while 80% are caused by the opposite problem: too little blood reaching the brain area, which is usually caused by a clot that has blocked a blood vessel. This is called “ischemic stroke.” This type of stroke can sometimes lead to a brain hemorrhage because the affected brain tissue softens and can lead to rupture of small blood vessels.

Moreover, brain hemorrhage can be caused when people have problems forming blood clots, which are the natural way in which the body stops any bleeding. The clots are formed by proteins called coagulation factors and by sticky blood cells called platelets. In any case in which the clotting factors or platelets do not work well or are insufficient in quantity, people may develop a tendency to bleed excessively.

Some medications (which, ironically, are often used to prevent ischemic stroke) prevent clot formation. They work by blocking the production of clotting factors (such as the anticoagulant warfarin) or interfering with platelet function (such as aspirin). The most common side effect of these drugs is bleeding, which may occasionally affect the brain. Controlling bleeding to avoid stroke is a very fine balancing act.

Illicit drugs such as cocaine, can also cause hemorrhagic stroke

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