Cerebral hemorrhage (intracerebral hemorrhage) and cerebral infarction (ischemic stroke), often collectively referred to as “stroke,” have fundamentally different mechanisms of onset, fatality rates, treatments, and keys to prevention. While cerebral infarction is overwhelmingly more common, occurring 2 to 3 times more frequently annually and showing significant treatment advancements, the threat of cerebral hemorrhage remains significant, with a high fatality rate of 30–50%.
Cerebral Hemorrhage vs. Cerebral Infarction: The 2025 Latest Ultimate Comparison Table
| Item | Cerebral Hemorrhage (Intracerebral Bleeding) | Cerebral Infarction (Cerebral Blockage) |
| Onset Mechanism | Blood vessel in the brain ruptures, leading to bleeding → Hematoma compresses the brain | Blood vessel in the brain is blocked, blood flow stops → Brain tissue dies (necrosis) |
| Annual Cases in Japan | Approx. 40,000–50,000 | Approx. 100,000–120,000 (2-3 times more) |
| 30-Day Mortality Rate | 30–50% (Over 70% in severe cases) | 8–15% |
| Average Age of Onset | 55–70 years old (Slightly younger) | 65–85 years old |
| Most Common Cause | Hypertension (70% of total cases) | Atrial Fibrillation + Atherosclerosis |
| Timing of Onset | Most often during activity (daytime) | Night to early morning (often while sleeping) |
| Primary Initial Symptom | Severe headache “like being hit by a bat” + Vomiting | Hemiparesis (paralysis on one side) + Speech difficulty (headache is mild or absent) |
| Likelihood of Loss of Consciousness | Very fast (coma possible in minutes) | Slow (even with large vessel occlusion, takes tens of minutes to a few hours) |
| Treatment Golden Time | Within 6 hours of onset (Lowering BP + Surgery consideration) | Within 4.5 hours (t-PA) / Up to 24 hours (Clot Retrieval) |
| Main Treatment | Lowering blood pressure to under 140 + Craniotomy / Stereotactic surgery | t-PA intravenous drip + Endovascular thrombectomy (Clot Retrieval) |
| Frequency of Surgery | Approx. 20–30% (If hematoma is large) | Approx. 15–25% (Thrombectomy procedures) |
| Average Hospital Stay | 3–12 weeks (Severe cases: over 6 months) | 3–6 months (Including rehabilitation for recovery) |
| Severity of After-effects | High rate of bedridden state if bleeding volume is large | Many people recover with minimal disability if thrombectomy is successful |
| Recurrence Rate (Within 5 yrs) | Approx. 10–15% (Lower if BP is well-controlled) | Approx. 20–30% (Higher with Atrial Fibrillation) |
| Most Important Prevention | Strictly maintain blood pressure below 130/80 | Detection of Atrial Fibrillation + Anticoagulants + No smoking |
| Most Useful Diagnostic Image | Head CT scan (Bleeding appears pure white) | Head MRI Diffusion-Weighted Imaging (Infarction appears pure white) |
| When Family Should Call 911 | “Sudden severe headache + vomiting” | “Sudden inability to move one side of the limbs + inability to speak” |
The Difference in a Nutshell
| Cerebral Hemorrhage | Cerebral Infarction | |
| Mechanism | “Vessel ruptures” → Headache + Loss of consciousness | “Vessel blocks” → Paralysis + Inability to speak |
| Treatment | Lowering blood pressure + Surgery consideration | Dissolving/Removing the clot |
| Prevention | Blood pressure management is vital | Atrial fibrillation + Lifestyle disease management |
| Outlook | Often irreversible once bleeding occurs | Many people have zero after-effects with early treatment |
Summary
- Severe headache + Vomiting → Suspect Cerebral Hemorrhage
- Hemiparesis + Inability to speak (No headache) → Suspect Cerebral Infarction
- In either case, “Call 911 as fast as possible, even by one minute” saves lives.
Both cerebral hemorrhage and cerebral infarction are serious, but the “method of prevention” and “initial response”are completely different.
