Medical Question #1 - Difference Between Strokes and Hemorrhages

Can someone tell me what they are?

“A wise man will not leave the right to the mercy of chance, nor wish it to prevail through the power of the majority. There is but little virtue in the action of masses of men.”
– Henry David Thoreau

A hemorrhage is an time a blood vessel breaks and blood leaks out. When this happens in the brain, it can cause a stroke. If it’s bad enough, it can cause death by cerebral hemorrhage.

A hemorrhage is blood leaking out where it shouldn’t; e.g., a paper cut, a stab wound, or a vessel rupturing inside the brain.

A stroke is caused by a hemorrhage in the brain. It is damage to the brain because of lack of blood to tissues or pressure from the accumulated blood.

The way you worded it you just said “hemorrhage,” not “cerebral hemorrhage.”

I’m assuming that you meant the latter.

What we call “strokes” fall into three main categories:

Cerebral hemorrhage–where a blood vessel bursts.

Cerebral thrombosis–where a blood vessel is blocked by a clot.

Cerebral embolism–where a blood vessel is blocked by some foreign object (including a clot) that has migrated from another part of the body.

So, bottom line is not all strokes involve bleeding.

(The medical types can give you all the tekkie terms and show you how I overgeneralized :), but that info is at least close.)

Absolutely right, actually. We med types call them CVA’s, or cerebral vascular accidents. Just to add that a stroke can either be temporary ( the clot dislodges, or there is a vascular spasm which relaxes), and cause damage that is reversable, i.e. the person will recover completely or mostly. Or it can be permanent, long enough interruption that part of the brain dies, and the person has lost the ability to speak or use an arm or walk. Also, one incidence of stroke increases the incidence for further strokes. Usually because of damage from the first incident.

A few clarifications:

Short answer - not all strokes are caused by bleeds (hemorrhages)
- not all hemorrhages inside the skull cause strokes

Long answer:

Strokes are basically the sudden loss of some neurologic function (movement, speech, vision, memory) caused by a blocked or burst blood vessel.

Most strokes are embolic; plaque from the carotid artery breaks off, and heads towards the brain, & ultimately finds an artery smaller than it is, and gets stuck, thus blocking blood flow to the area served by that artery. In the area that gets all of it’s blood from that artery, most of the neurons (nerve cells) die. In the surrounding area that gets blood from other arteries in addition to the blocked one, neurons don’t work well, but can recover (few days). Further recovery is possible if other areas of the brain can learn to perform the function of the area destroyed by the stroke (weeks-months). Clot-busters (TPA, Streptokinase) are being used in these strokes with moderate success. Surgery to clean out the plaque in the carotid arteries is often done to prevent these strokes. These kind of strokes often are preceded by warning attacks, called TIAs (Transient Ischemic* Attacks) with the same symptoms of a stroke, but with complete recovery, usually within 30 minutes or so. *Ischemia = low blood flow.

Thrombotic strokes occur when the clot actually develops in the blood vessel inside the brain. A similar pattern of cell death & partial cell damage as in embolic strokes occur. Usually this occurs in a person with some kind of inflammatory process going on inside the blood vessels (vasculitis). Clot busters also work for this kind of stroke.

Hemorrhagic strokes occur when a blood vessel bursts inside the brain. Because they often cause significant brain swelling, these are usually the most devasting, disabling strokes, and are the most likely to be fatal immediately or shortly after the event. Obviously, clot-busting drugs cannot be used here (since bleeding is the most worrisome side effect of these drugs).

Depending upon where inside the skull a blood vessel breaks, several hemorrhage syndromes can occur:

Stroke (see above) if the bleeding occurs into the brain tissue.

Subarachnoid hemorrhage - blood leaks into the fluid around the brain, causing headache & neck pain, similar to what is seen with meneingitis.

Subdural hemorrhage - blood leaks into a space between the bone & the dura (membrane separating the brain & the skull). Pressure builds up & several days after a head injury, a person begins acting strangely, gets confused, and eventually loses consciousness & dies if the blood creates a large enough mass (hematoma). Full recovery possible if pressure relieved by drilling a hole in the skull & draining out the blood.

Subepidural hemorrhage - blood pools between layers of the membranes separating brain & bone. The person is alert after a head injury, then within a few hours suddenly loses consciousness - can be fatal, or, if prompt surgery to relieve pressure is done, can have no permanant damage.

Disclaimer: If you believe someone has had a head injury, stroke, or hemorrhage, do not use the above information to diagnose and treat them. Call 911.

The information regarding strokes is fairly up-to-date/accurate. The information regarding different kinds of hemorrhages is as best I can recall from long ago surgical & ER rotations. I welcome any corrections that may be appropriate…

Sue from El Paso

Thank you very much, Majormd.

My mom is in the hospital now. She’s had some head and neck pain over the last few days, and she called her doctor yesterday, who told her to go to the ER last night. I’ll let you know more as I get more details.

Gee, San, I hope she is doing OK, & that she has no permanant effects from this. My best wishes (and prayers if appreciated) are with you, her, and your family.

I hope the doctors are explaining things to you all in terms that you can understand. E-mail me if additional information would help you (but I’m only on late at night).

  • Sue