Quick Answer
Ischemic stroke is a blocked brain artery (85% of cases) — treated with tPA/EVT within 4.5–24 hours. Hemorrhagic stroke is a burst artery (15%) — 2–3× higher 30-day mortality, but survivors often recover better long-term because tissue around the bleed is compressed, not dead. Rehab protocols are identical; timing differs.
1. Different Causes
Ischemic strokes come from clots — usually atherosclerosis or atrial fibrillation. Hemorrhagic strokes come from ruptured vessels — most often chronic hypertension, followed by aneurysm or AVM.
2. Symptoms Overlap, But Warning Signs Differ
Both share FAST symptoms. Hemorrhagic stroke often adds:
- Sudden severe "thunderclap" headache (never felt before)
- Projectile vomiting, neck stiffness
- Rapid loss of consciousness within minutes
- Very high blood pressure at ER arrival (>180/100)
3. Acute Treatment — Opposite Directions
Ischemic requires clot removal — tPA within 4.5 hours, EVT within 24 hours. Hemorrhagic requires bleeding control — SBP <140 mmHg, surgical evacuation if clot is large (AHA/ASA 2022 ICH Guidelines). tPA is absolutely contraindicated in hemorrhagic stroke.
4. Mortality and Recovery
30-day mortality: hemorrhagic ~40% vs ischemic 10–15% (van Asch, Lancet Neurol 2010). However, survivors of hemorrhagic stroke past 90 days often show better functional recovery than ischemic survivors because perihematomal tissue is compressed, not necrotic — when blood is reabsorbed, function returns.
5. Rehabilitation — Same Protocol, Different Timing
Both use neuroplasticity-based intensive rehabilitation (Winstein AHA/ASA 2016):
- Ischemic — early mobilization within 24–48 hours
- Hemorrhagic — CT confirmation of stable hematoma at 72 hours before rehab
- Then identical: intensive PT/OT 2–3 sessions daily
- At Sanpiti: 2.6-month average stay, 87% walking before discharge (both types)
Frequently Asked Questions
Is hemorrhagic stroke more dangerous than ischemic?
In the first 30 days, yes — mortality is 40% vs 10-15%. But survivors past 90 days often recover better long-term because tissue around the bleed frequently regains function.
How do you know if it is ischemic or hemorrhagic?
CT scan within 25 minutes of ER arrival — AHA/ASA standard. Treatment differs completely (tPA saves ischemic, kills hemorrhagic).
Does hemorrhagic stroke rehab start later?
Yes, typically 3-7 days later to allow bleeding to stop. After that the protocol is identical, and 6-month functional outcomes are comparable when both receive intensive rehab during the Golden Period.
Do both types need the same rehab team?
Yes — both need a full multidisciplinary team: PM&R physician, PT, OT, SLP, rehab nursing. At Sanpiti this team is present at all 9 branches.
Rehabilitation for Both Stroke Types
Sanpiti's 9 inpatient branches treat both ischemic and hemorrhagic stroke with the same evidence-based multidisciplinary protocol.