Compared to the clinical research of ischemic stroke, the successes in hemorrhagic stroke are manageable. Nevertheless, clinical research can also be simplistically divided into two areas.

• Acute hemorrhagic stroke
• Prevention of hemorrhagic stroke

Acute hemorrhagic stroke

Cerebral hemorrhages are caused by damage to vessels inside the skull, allowing blood to leak from the vessel and damage surrounding structures. Brain tissue is surrounded from the inside out by three meninges (pia mater, arachnoid mater and dura mater). Depending on the location of the vascular damage, a distinction can be made between different types of hemorrhage. The most important are:

• Intracerebral hemorrhage: a hemorrhage within the brain tissue
• Subarachnoid hemorrhage: a hemorrhage between the inner and middle meninges of the brain
• Subdural hemorrhage: a hemorrhage between the middle and outer meninges of the brain
• Epidural hemorrhage: a hemorrhage outside the outer meninx

As a result of a cerebral hemorrhage, brain tissue may be damaged directly or indirectly. As with ischemic stroke, the dogma "time is brain" also applies to cerebral hemorrhage. Accordingly, affected patients should be taken as quickly as possible to a center specializing in cerebral hemorrhage and treated and monitored as quickly as possible (cf. ischemic stroke section).

Prevention of hemorrhagic stroke

Hemorrhagic stroke has a particularly poor natural history and - unlike ischemic stroke - acute treatment options are still rather limited. Thus, preventing death or permanent disability from hemorrhagic stroke mainly relies on preventing its occurence in the first place.

As with ischemic stroke, primary and secondary prevention can be distinguished. Primary prevention is aimed at reducing the risk of suffering a first-time hemorrhagic stroke by means of lifestyle modifications and treatment of vascular risk factors. Similar to primary prevention of ischemic stroke, this includes a healthy diet and weight loss, regular physical activity, smoking cessation, and management of hypertension, diabetes mellitus, and lipid disorders. Prior treatment with anticoagulants may increase the risk for systemic bleeding complications including hemorrhagic stroke.

Secondary prevention aims to reduce the risk of recurrence after a first-time hemorrhagic stroke. Apart from maintaining basic preventive measures used for primary prevention, this may involve treatment of specific underlying causes including vascular malformations, aneurysms, tumors, and bleeding disorders (hemophilia). Preexisiting treatment with anticoagulants likely requires (temporary) discontinuation, depending on the individual indication.