An intracerebral hemorrhage is usually diagnosed in an emergency room since its urgent symptoms come on so suddenly. An emergency room doctor will diagnose a hemorrhagic stroke based on the physical symptoms as well as other tests, including most commonly a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan, and blood tests.
An accurate diagnosis is critical, especially distinguishing a hemorrhagic stroke from an ischemic stroke. Treatment for hemorrhagic stroke involves stopping the bleeding as quickly as possible to minimize damage to the brain. An ischemic stroke, caused by a blood clot or blocked blood vessel (see Carotid Occlusive Disease), is often treated with blood thinning drugs or anticoagulant medications, which would worsen the effects of a hemorrhagic stroke.
Most bleeds are self-limiting, with damage related to the specific location of the bleed. Treatment in the emergency room may include medication to lower blood pressure, to stop seizures, or to slow swelling. The goal of medical treatment is to stop or minimize the bleeding and reduce the buildup of pressure caused by the hematoma.
Historically, the medical treatment for hemorrhagic stroke was to slow the bleeding by lowering blood pressure, wait for the hematoma to dissolve over time, and then – if the patient survived – begin speech and physical therapy to regain lost function. Today, hemorrhagic stroke may be treated with surgery to stop the bleeding, prevent the expansion of the pool of blood (the hematoma), and repair the torn blood vessel. (See Surgery for Intracerebral Hemorrhage).
Reviewed by: Philip E. Stieg, PhD, MD
Last reviewed/last updated: April 2021