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Ischemic vs. Hemorrhagic Stroke: Difference, Diagnosis, and Treatment

Medically Approved by Dr. Edward Salko

Table of Contents

Doctor at work holding a heart

Stroke affects more than 795,000 Americans each year. It’s also no secret that it is one of the leading causes of disabilities among adults. That said, it is imperative to understand more about the condition, starting with the difference between ischemic and hemorrhagic stroke.

While almost everyone is familiar with stroke, most people only encounter the fact that there are different forms of stroke when they have someone in the family affected by the disease or if they work in the medical field.

Simply out, ischemic stroke occurs due to the blockage in the artery, typically due to high deposits of fats in the arterial walls. While hemorrhagic stroke happens when the artery bursts resulting in blood leaking out of the blood vessel. Both types of stroke impede blood flow in the brain. 

Learning the details related to ischemic vs. hemorrhagic stroke increases your awareness of the risk factors and preventive measures you can employ. Find out more about these types of stroke as you read further. 

How To Differentiate Ischemic and Hemorrhagic Stroke  

The primary difference between ischemic and hemorrhagic stroke lies in how the blood flow in the artery is interrupted, leading to brain tissue damage. Likewise, ischemic stroke is more common, comprising about 87% of stroke cases, while hemorrhagic makes up to only 10% to 20%

With the ischemic stroke, the patient experiences cerebral hypoxia or oxygen shortage in the brain due to the blood failing to pass through the clogged artery. In most cases, the blockage can be due to plaque buildup composed of hardened cholesterol or blood clots. 

There are two types of ischemic stroke based on where the blood clot develops. When the clotting forms in the artery going towards the brain, it is identified as a thrombotic stroke. Meanwhile, if the blood clot forms in other blood vessels, travels, and gets stuck in the cerebral artery, that is known as an embolic stroke. 

Hemorrhagic stroke, on the other hand, is a result of a ruptured artery causing hemorrhage in the brain.  There are two types of hemorrhagic stroke based on where the bleeding occurs. The first one, called intracerebral hemorrhage, is characterized by bleeding within the brain tissue. The other one, known as subarachnoid hemorrhage, is bleeding of the artery on the surface of the brain.      

How To Determine Ischemic vs Hemorrhagic Stroke

Stroke, in general, has distinctive symptoms which include the following:

  • Lack of coordination exhibited by loss of balance and dizziness
  • Problem seeing in one or both eyes
  • Trouble with speech comprehension or speaking in general
  • Numbness or sudden weakness felt in one side of the body such as the face, arm, and leg 
  • Nausea and vomiting
  • Loss of consciousness

For individual experiencing ischemic stroke, the mentioned symptoms often show up one by one or altogether. On the other hand, with hemorrhagic stroke, patients might also experience sudden headache on top of the said stroke symptoms. 

Is Hemorrhagic or Ischemic Stroke Worse?

As hemorrhagic stroke involves bleeding in the brain tissue and arterial damage, it is deemed more life-threatening than ischemic stroke. 

According to a study published at the Journal of Stroke and Cerebrovascular Disease, intracerebral hemorrhage has a higher mortality rate. Also, the long term complications can be far more severe than that of ischemic stroke such as permanent memory problems, comatose, and even epilepsy. 

Nonetheless, ischemic stroke also pose cognitive problems that can have the same gravity as that of hemorrhagic stroke. But treatments are often more available depending on the severity of the stroke.  

Are There Other Types of Stroke?

Hemorrhagic and ischemic are the two most prominent types of stroke but there’s also the transient ischemic attack (TIA), more commonly known as a mini stroke. While TIA is essentially ischemic in nature, it is taken out from the group as it occurs temporarily. It usually lasts for a few minutes and does not have life-threatening impact such as permanent tissue damage.

Risk Factors for Stroke 

Female doctor measuring blood pressure to older patient sitting at sofa.

While it’s true that stroke can happen to anyone, anytime, some people have higher affinity for the disease due to the following risk factors:

  • High blood pressure (hypertension)
  • Alcohol depency 
  • High Cholesterol
  • Atherosclerosis
  • Atrial fibrillation 
  • Heart damage
  • Family history
  • Illicit drug use 
  • Prior stroke
  • Diabetes 
  • Obesity
  • Old age

With ischemic stroke, your cholesterol level becomes one of the biggest risk factors. In that sense, you could benefit from regular monitoring and blood tests for cholesterol and other types of fats through a lipid panel blood test

On the other hand, you can experience hemorrhagic stroke even with robust health if you have been in an accident. Concussion can lead to a stroke especially if there is severe bruising or impact in the brain tissue resulting in bleeding.  

Ischemic Stroke vs. Hemorrhagic Stroke Diagnosis 

Brain scans are often performed to diagnose a stroke. Your doctor will request for an imaging test to detect the blood clot in the cerebral artery. Aside from these tests, you will also most likely take blood tests such as a lipid panel blood test and a glucose blood test.

Here are the diagnostic tests and procedures a patient suspected with stroke could expect:

Computerized Tomography (CT) Scan: This procedure allows your doctor to locate the spot in the cerebral artery where the blockage or rupture occurred. The image produced is similar to that of a regular chest X-ray.

Magnetic Resonance Imaging (MRI) Scan: An MRI is another imaging test that uses the interaction between radio waves and a magnetic field to produce a detailed image of the damaged brain tissues.

Blood Tests: High cholesterol and glucose in the blood increases your susceptibility to stroke. Hence taking the blood tests for these parameters become instrumental in identifying the type of stroke the patient has. 

Echocardiogram: This procedure provides vital information on blood clots that formed outside the cerebral artery. The ultrasound helps identify the source of the clot that might have caused the stroke. 

Carotid Ultrasound: Your doctor may request or perform this test to get a better image of the fats building up in the carotid artery, the major blood vessel that leads to the brain, beck, and face.  

Treatments for Stroke 

The kind of stroke treatment plan depends on the type, and severity of the condition, especially if it is an emergency. Below are some references on how doctors treat ischemic and hemorrhagic stroke.

Ischemic stroke: IV medications, endovascular therapy, surgical removal of plaques, and angioplasty 

Hemorrhagic stroke: surgical clipping, endovascular embolization, stereotactic radiosurgery, surgical AVM removal, and blood transfusion

These measures are intended to correct the blockage and treat the damaged blood vessels. However, since the condition could have neurological effects such as difficulty walking, speech problems, and other cognitive issues, additional treatments are recommended to correct these impacts. 

For example, your mobility might be compromised after experiencing a stroke. Fortunately, you can regain your motor abilities with physical therapy and certain medications. 

Bottom Line 

In the battle between ischemic vs hemorrhagic stroke, nobody’s a winner except those who understand the simple ways to prevent them. With that, knowing the difference between the two allows you to look closer into your risks. Take what you know and get yourself checked, especially your cholesterol level to ensure that blood flow to your brain remains smooth.  

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