Brain Haemorrhage (Haemorrhagic Stroke): Recovery Time, With or Without Surgery

A brain haemorrhage (haemorrhagic stroke) is one form of stroke. Around 85% of strokes are ischaemic, caused by a blocked artery, and around 15% are haemorrhagic, caused by bleeding. Many brain haemorrhages are mild or moderate, and rehabilitation principles are largely the same for both types. For the full picture, start with our main guide: Stroke rehabilitation: ischaemic and haemorrhagic stroke.

Families of someone who has had a brain haemorrhage usually want answers to two questions: what are the chances, and how long will recovery take? This page addresses both in the light of current guidelines and research. Every patient is different, and this information does not replace a conversation with the treating team.

Types of brain haemorrhage

• Intracerebral haemorrhage (ICH): bleeding into brain tissue, most often caused by high blood pressure.
• Subarachnoid haemorrhage (SAH): bleeding between the brain’s membranes, frequently from a ruptured aneurysm [7].
• Subdural haematoma: blood collecting beneath the dura, usually after head trauma.

Further reading: the guide “Stroke” and the articles Ischaemic Stroke: Treatment, Rehabilitation and Recovery and Stroke Recovery Timeline: What to Expect Month by Month.

What determines survival and outcome?

The widely used ICH score combines level of consciousness (Glasgow Coma Scale), haematoma volume, extension into the ventricles, location in the brainstem or cerebellum, and age over 80 [1]. In population studies, case fatality at one month after intracerebral haemorrhage averaged around 40%, with little improvement over recent decades [2].

An important caveat: the current guideline recommends continuing aggressive care early on, and not using prognostic scores alone to limit treatment [3].

Recovery time with and without surgery

Neurosurgeons decide on surgery based on the bleed’s location and size, consciousness and brain swelling. The STICH trials did not show an overall benefit of early surgery over initial conservative treatment for supratentorial haemorrhages, including superficial lobar ones [4, 5]. For cerebellar haemorrhage or brainstem compression, surgery may be life-saving [3].

For recovery time, the severity and location of the bleed matter more than whether an operation was performed. Most patients improve fastest in the first 3–6 months, and gains may continue more slowly afterwards.

Right-sided vs left-sided haemorrhage

Left-hemisphere bleeds usually cause right-sided weakness and language problems (aphasia). Right-hemisphere bleeds can cause left-sided weakness, neglect of the left side, and attention and perception problems.

The recovery process: acute care, rehabilitation, return home

1. Acute phase: blood-pressure control, reversal of clotting problems and monitoring of intracranial pressure in intensive care or a stroke unit
2. Early rehabilitation: positioning, breathing, swallowing and early mobilisation once medically stable [3, 6]
3. Intensive rehabilitation: physiotherapy, occupational therapy, speech and swallowing therapy, cognitive rehabilitation and, where suitable, robot-assisted therapies (Robotic rehabilitation)
4. Return home and follow-up: home programme, regular reviews and risk-factor management

Psychological and cognitive changes

Depression, anxiety, emotional lability, personality change and attention and memory problems may follow a brain haemorrhage, and some patients develop seizures. These need to be recognised and treated, as they directly affect rehabilitation.

Can it happen again? Prevention

There is a risk of recurrence. High blood pressure is the most important modifiable risk factor. Keeping blood pressure at target, stopping smoking and heavy drinking, and using blood thinners only under medical supervision are recommended [3].

Frequently asked questions

What are the chances of survival after a brain haemorrhage? They depend on the type, volume and location of the bleed, consciousness and age. Average figures cannot give a definite answer for one patient, and the treating team is the best source.

How long does recovery take with surgery? Recovery time depends mainly on the severity and location of the bleed. Most improvement occurs in the first 3–6 months.

Can a brain haemorrhage heal without surgery? Many intracerebral haemorrhages are treated without surgery. The decision rests with the neurosurgical team.

When should rehabilitation start? As early as appropriate, once the patient is medically stable and the team agrees.

Assessment and contact

You can request an appointment or a second-opinion review of existing reports and imaging: Contact & second opinion (WhatsApp). This page is general health information. Diagnosis and treatment decisions are made individually after examination.

Sources

1. Hemphill JC 3rd, et al. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001. PMID: 11283388
2. van Asch CJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010. PMID: 20056489
3. Greenberg SM, et al. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2022. PMID: 35579034
4. Mendelow AD, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005. PMID: 15680453
5. Mendelow AD, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013. PMID: 23726393
6. Winstein CJ, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016. PMID: 27145936
7. Hoh BL, et al. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2023. PMID: 37212182