Stroke is one of the primary causes of mortality and disability globally, and it is classified into two types: hemorrhagic and ischemic strokes. Understanding the differences between these two categories is critical for identifying symptoms, obtaining immediate treatment, and comprehending the long-term consequences. While both strokes affect blood flow to the brain, they do so in quite different ways, resulting in distinct treatment tactics and outcomes.

In this post, we will look at the important similarities and differences between hemorrhagic and ischemic strokes, such as their causes, symptoms, treatment choices, and long-term consequences.

What is a Stroke?

A stroke happens when the blood supply to a portion of the brain is disrupted or diminished, depriving brain tissue of oxygen and nutrients. Brain cells start to die within minutes, therefore early detection and treatment are critical for reducing brain damage and improving outcomes. Strokes are medical crises that must be treated as soon as possible to restore normal blood flow and prevent additional damage.

Major Types of Stroke

• Ischemic Stroke: This is caused when a blood clot plugs a blood vessel in the brain, stopping blood from reaching crucial places. It accounts for over 87% of all stroke cases.
• Hemorrhagic Stroke: This occurs when a blood artery in the brain ruptures, resulting in bleeding either within the brain (intracerebral hemorrhage) or between the brain and its surrounding membranes (subarachnoid hemorrhage). Hemorrhagic strokes account for around 13% of all strokes, but have a higher fatality rate.

Causes: Hemorrhagic Stroke vs Ischemic Stroke

The underlying causes of hemorrhagic and ischemic strokes are unique because they involve opposite problems with blood vessels—blockage vs rupture.

Causes of Ischemic Stroke

An ischemic stroke happens when a blood clot or other particles clog the blood arteries in the brain. The most prevalent causes of an ischemic stroke are:

• Atherosclerosis: The accumulation of fatty deposits or plaques in the arteries over time, causing them to constrict or harden. These plaques can burst, resulting in blood clots that obstruct blood flow to the brain.
• Embolism: This occurs when a clot forms in another region of the body, typically the heart (as in atrial fibrillation), and travels via the bloodstream to the brain, where it lodges in a smaller artery, shutting off blood supply.
• Thrombosis: This is when a clot forms directly inside one of the brain’s blood arteries. This is frequently related with underlying diseases such as excessive cholesterol or diabetes.

Causes of Hemorrhagic Stroke

Hemorrhagic stroke results from the rupture of weaker blood arteries, which causes bleeding into or around the brain. The principal causes are:

1. Hypertension (High Blood Pressure): Chronic high blood pressure weakens blood vessel walls, making them susceptible to rupture.
2. Aneurysms: These are balloon-like bulges in blood vessels that can burst under pressure, resulting in cerebral hemorrhage.
3. Arteriovenous Malformations (AVMs): These are aberrant tangles of blood arteries that can burst and cause bleeding. These abnormalities are typically congenital.
4. Head Trauma: Severe impacts to the head can cause bleeding within the brain, culminating in a hemorrhagic stroke.
5. Blood Thinners and Coagulation Diseases: Taking anticoagulant drugs (such as warfarin) or having blood diseases that affect clotting can increase the risk of hemorrhage.

Symptoms: Hemorrhagic Stroke vs Ischemic Stroke

Despite their differing causes, hemorrhagic and ischemic strokes often have similar symptoms because they both disrupt brain function. However, there are subtle variances in how these symptoms appear.

Common Symptoms of Both Stroke Types:

• Sudden Weakness or Numbness: Usually affects one side of the body, particularly the face, arm, or leg.
• Difficulty Speaking and Understanding Speech: Difficulties speaking or understanding speech include slurred speech and difficulty finding the correct words.
• Vision Problems: Vision difficulties include sudden vision loss or blurring in one or both eyes.
• Loss of Balance or Coordination: Loss of balance or coordination might manifest as difficulty walking, dizziness, or a lack of coordination.
• Sudden Confusion: difficulty comprehending or processing information.

Symptoms Specific to Hemorrhagic Stroke:

• Severe Headache: Often referred to as the “worst headache of my life,” this symptom is more commonly associated with hemorrhagic stroke, particularly subarachnoid hemorrhage.
• Nausea and vomiting: These are possible side effects of the increased pressure on the brain caused by the hemorrhage.
• Hemorrhagic Strokes: These are more likely to result in a rapid decline in consciousness, such as fainting or coma.
• Seizures: Sudden seizures can occur in hemorrhagic stroke patients as a result of bleeding-induced brain inflammation.

Symptoms Specific to Ischemic Stroke:

• Gradual Symptom Onset: Unlike hemorrhagic stroke, which often has an abrupt onset, ischemic stroke symptoms can build gradually over minutes or hours.
• Transient Ischemic Attacks (TIAs): Sometimes known as “mini-strokes,” are common precursors to ischemic stroke. They have symptoms similar to a complete stroke yet resolve within 24 hours without causing permanent damage.

Diagnosis: Hemorrhagic Stroke vs Ischemic Stroke

Prompt diagnosis is critical in distinguishing between hemorrhagic and ischemic strokes because the therapies for each varies greatly. In Singapore and other nations with advanced healthcare systems, diagnostic imaging is critical in detecting the type of stroke.

Diagnostic tests for both stroke types:

• Computed Tomography (CT): This scan is the primary imaging test for a stroke. It can promptly identify hemorrhagic stroke by detecting blood in the brain and distinguishing it from ischemia.
• Magnetic Resonance Imaging (MRI): MRI provides more detailed images of brain tissue and can detect small areas of ischemic stroke that a CT scan may miss.
• Angiography: This imaging technique uses dye to see blood arteries in the brain. It is especially valuable in determining the origin of hemorrhagic stroke, such as aneurysms or AVMs, and in detecting blocked arteries during ischemic stroke.
• Blood Tests: Blood tests may be performed to determine clotting function, cholesterol levels, or other health factors that contribute to stroke risk.

Treatment: Hemorrhagic Stroke vs Ischemic Stroke

The treatment for hemorrhagic stroke differs greatly from that for ischemic stroke due to the distinct processes at work.

Treatment of Ischemic Stroke:

• Thrombolysis (Clot-Busting Drugs): The main treatment for ischemic stroke is intravenous tissue plasminogen activator (tPA) to destroy the clot. This must be given within 4.5 hours after symptom onset.
• Endovascular Thrombectomy: A mechanical thrombectomy may be used to treat big clots. This surgery entails passing a catheter through the arteries to physically remove the clot.
• Antiplatelet and Anticoagulant Therapy: Medications such as aspirin and warfarin are used to thin the blood and prevent further clots.

Treatment for Hemorrhagic Stroke:

• Surgical Intervention: In the case of severe bleeding, a craniotomy may be performed to relieve pressure by removing a portion of the skull. Surgeons can also repair damaged blood arteries and remove blood clots.
• Aneurysm Clipping or Coiling: If the stroke was caused by a ruptured aneurysm, surgical clipping or endovascular coiling may be performed to control bleeding and prevent future strokes.
• Blood Pressure Control: Because hypertension is a major risk factor for hemorrhagic stroke, managing blood pressure is crucial in both acute and long-term prevention.
• Medication to Control Brain Swelling: If brain swelling is caused by bleeding, drugs can be given to relieve intracranial pressure and avoid additional brain injury.

Prognosis and Recovery: Hemorrhagic Stroke vs Ischemic Stroke

Recovery from a stroke is determined by the severity of the occurrence, the area of the brain damaged, and how promptly treatment is began.

Prognosis for Ischemic Stroke:

• Higher Survival Rate: Ischemic strokes have a higher survival rate than hemorrhagic strokes, particularly if treated early.
• Long-Term Rehabilitation: Many ischemic stroke survivors require long-term rehabilitation, such as physical therapy, occupational therapy, and speech therapy, to restore function.

Prognosis of Hemorrhagic Stroke:

• Higher Mortality Rate: Hemorrhagic strokes, particularly intracerebral hemorrhages, are more likely to result in death or severe disability than ischemic strokes. Approximately 40% of individuals with hemorrhagic stroke die within the first month.
• More Severe Long-Term Effects: Survivors of hemorrhagic stroke frequently experience more substantial obstacles, such as long-term cognitive impairment, physical handicap, or trouble speaking and moving.

Prevention: Hemorrhagic Stroke vs Ischemic Stroke

Prevention techniques for both forms of stroke overlap in many ways, as treating risk factors such as high blood pressure, cholesterol, and smoking is critical for both.

Preventing Ischemic Stroke:

• Control Hypertension: Maintaining a healthy blood pressure through lifestyle changes or medication can help prevent blood vessel blockages.
• Manage Diabetes and Cholesterol: Controlling blood sugar and cholesterol levels lowers the risk of atherosclerosis.
• Smoking Cessation: Quitting smoking is an important step in stroke prevention since it increases clot formation and destroys blood vessels.

Preventing Hemorrhagic Stroke:

• Control Blood Pressure: Uncontrolled high blood pressure is the major cause of hemorrhagic stroke, hence hypertension must be monitored and managed.
• Avoid Blood Thinners Unless Necessary: To reduce the danger of bleeding, blood thinners should only be used under rigorous medical supervision.
• Limit Alcohol and Avoid Drug Use: Excessive alcohol use and stimulant substances such as cocaine can significantly raise the risk of brain hemorrhage.

Frequently Asked Questions (FAQs)

1. What’s the distinction between ischemic and hemorrhagic strokes?

An ischemic stroke occurs when a blood clot prevents blood flow to the brain, but a hemorrhagic stroke occurs when a blood artery in the brain ruptures, resulting in hemorrhage.

2. Which form of stroke is most common?

Ischemic strokes are more common, accounting for roughly 87% of all strokes, while hemorrhagic strokes account for the other 13%.

3. Can the symptoms of both types of stroke be the same?

Yes, both types can induce symptoms such as sudden weakness, trouble speaking, and vision issues; however, hemorrhagic stroke is more likely to cause severe headaches and loss of consciousness.

4. What is the treatment for an ischemic stroke?

The primary treatment for ischemic stroke is clot-busting medications such as tPA, with mechanical clot removal (thrombectomy) for larger clots.

5. What is the treatment for a hemorrhagic stroke?

Hemorrhagic stroke treatment frequently includes surgery to repair damaged blood vessels, decrease brain swelling, and stop bleeding. Managing blood pressure is also critical.

6. Which stroke has the highest death rate?

Hemorrhagic strokes have a greater fatality rate than ischemic strokes because of the complexity of brain bleeding and the possibility of rapid worsening.

7. Can both types of strokes be prevented?

Yes, both types can be avoided by reducing risk factors such as high blood pressure, cholesterol, and smoking and leading a heart-healthy lifestyle.

Conclusion

While both ischemic and hemorrhagic strokes disrupt blood flow to the brain, their causes, symptoms, treatments, and outcomes differ significantly. Understanding these differences and seeking immediate medical attention at the first signs of a stroke can save lives and improve long-term recovery.

If you’re feeling uneasy about your heart health, it’s essential to speak with a doctor and explore the option of a cardiac biomarkers test in Singapore. Whether you’re showing signs of heart disease or simply seeking a regular heart check-up, early action is crucial. Reach out to the Harley Street Heart and Vascular Centre for a detailed assessment. Call +65 6235 5300 to schedule an appointment with one of our skilled cardiologists. Prioritize your heart today—your health is our number one priority!

Written by: Dr Michael MacDonald MB ChB, BSc (Hons), MRCP (UK), MD (Research), FESC (Europe).  Dr MacDonald was trained in the UK and is a senior Consultant Cardiologist.