Hemorrhagic Stroke

Hemorrhagic stroke is the result of bleeding in the brain. This bleeding is usually the result of blood vessel abnormalities or clotting disorders. Hemorrhagic stroke is also referred to as cerebral hemorrhage or intracranial hemorrhage. Occasionally, children with arterial ischemic stroke can develop hemorrhagic transformation of their initial stroke, meaning that bleeding can sometimes develop as a complication of the ischemic injury itself or the medicine used to treat it. About 45 percent of strokes in children are hemorrhagic in nature.

The symptoms of hemorrhagic stroke tend to occur suddenly and can include:

• Severe headaches
• Vomiting and nausea
• Irritability (in infants)
• Weakness or numbness of the face, arm, or leg, usually on one of side of the body
• Difficulty walking, seeing, speaking, or understanding
• Dizziness or loss of balance
• Seizures, sometimes followed by paralysis on one side of the body
• Loss of consciousness

If you suspect your child is having a stroke, don’t wait — go directly to an emergency room.

Hemorrhagic stroke is the result of bleeding in the brain, which can deprive that organ of the oxygen it needs. This is typically caused by blood vessel abnormalities such as cavernous malformations, arteriovenous malformations, venous angiomas, and aneurysms. An arterial dissection, a tear in the lining of an artery, can also lead to a hemorrhagic stroke. Clotting disorders such as hemophilia, sickle cell disease, brain tumors, and congenital heart disease can also cause bleeds that may lead to hemorrhagic stroke.

Evaluation of hemorrhagic stroke usually begins in the emergency room. Stroke specialists will conduct a rapid physical examination and the care team will work to quickly confirm and locate the cause of the stroke through imaging tests. These can include:

• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Ultrasound

All of these tests are painless and noninvasive, although some might require placement of an intravenous (IV) line to deliver agents needed for certain types of imaging. Since MRI requires a child to hold still inside a scanner, very young children may need sedation. In some cases, the physician may recommend blood tests to help identify any underlying disorders that might cause bleeding.

Treatment of hemorrhagic stroke depends on the cause. If the stroke was the result of a blood vessel abnormality, such as a cavernous malformation, arteriovenous malformation, or aneurysm, the physician will likely repair the abnormality to stem bleeding and prevent future strokes. In cases where a clotting disorder is responsible for the stroke, clinicians will treat the underlying problem to prevent future bleeds.

Regardless of the cause, most children who experience hemorrhagic strokes require long-term care to address the consequences of the stroke. Your child’s stroke team will create a comprehensive rehabilitation plan, which can involve physical, occupational, vision or speech and language therapies, or a combination of these.

The Boston Children’s Hospital Stroke and Cerebrovascular Center team provides fast, comprehensive evaluations to quickly identify if and why a stroke has occurred. To stop bleeding in the brain, we work with physicians in the Cerebrovascular Surgery and Interventions Center, who address the cause of the hemorrhage. For example, if the stroke was caused by a blood vessel abnormality, we may be able to use a surgical or neurointerventional procedure to correct the condition.

Our team also provides long-term care from a variety of specialists, so that your child has access to the combined expertise of child neurologists, pediatric neurosurgeons, hematologists, neurointerventional radiologists, pediatric neuroradiologists, emergency medicine physicians, child psychiatrists, physical and occupational therapists, and speech and language therapists.