Bleeding strokes strike earlier and harder in heavy drinkers

People who drink heavily may have bleeding strokes a decade earlier than people who are not heavy drinkers, according to a study published November 5, 2025, in Neurology^®, an official journal of the American Academy of Neurology.

Researchers found that people who regularly had three or more alcoholic drinks per day were more likely to experience intracerebral hemorrhage, a type of stroke caused by bleeding in the brain, at a younger age and with greater severity than people who had fewer than three drinks a day.

Researchers also found that heavy drinkers were more likely to show signs of cerebral small vessel disease, which is damage to small blood vessels in the brain and a type of long-term brain damage.

Intracerebral hemorrhage is the most deadly type of stroke with cerebral small vessel disease being its leading cause. While heavy drinking has been linked in previous studies to an increased risk of stroke, our findings suggest that it doesn't just increase the severity of a bleeding stroke, it may also accelerate long-term harm to the brain's small vessels."

M. Edip Gurol, MD, of Harvard University in Boston and member of the American Academy of Neurology

The study included 1,600 adults with an average age of 75 who were hospitalized for intracerebral hemorrhage. Information on alcohol use was provided during hospital admission, either by the patient or a person with them at the hospital.

Researchers defined heavy alcohol use as regularly drinking three or more alcoholic drinks per day with one drink having the equivalent to 14 grams, or 0.6 ounces, of alcohol. This is typically equal to 12 ounces of beer, five ounces of wine or 1.5 ounces of liquor. Of participants, 104 people, or 7%, met the criteria for heavy alcohol use.

Participants underwent brain scans to assess the severity of their strokes and to look for signs of cerebral small vessel disease. Researchers then compared heavy drinkers to participants who drank fewer than three drinks a day or not at all.

Researchers found heavy drinkers experienced stroke at an average age of 64 compared to an average age of 75 for non-heavy drinkers-an 11-year difference. They also had brain bleeds that were 70% larger on average. They were twice as likely to have bleeding in deep brain regions, and nearly twice as likely to experience bleeding that spread into the brain's fluid-filled spaces, a complication called intraventricular extension. Gurol said these findings typically indicate poorer recovery and health outcomes among people who had brain bleeds.

Heavy drinkers were more than three times as likely to show severe signs of white matter damage called white matter hyperintensities that are typically caused by cerebral small vessel disease. They also had nearly twice the odds of having a pattern of cerebral small vessel disease that reflects chronic damage caused by high blood pressure.

Additionally, they had lower blood platelet counts and slightly higher blood pressure upon hospital admission than non-heavy drinkers, factors that may again contribute to stroke severity and how well a person recovers.

"Reducing heavy alcohol use may not only lower a person's risk of bleeding stroke, it may also slow the progression of cerebral small vessel disease, which in turn may reduce the chances of having another stroke, cognitive decline and long-term disability," said Gurol. "Promoting lifestyle changes like quitting alcohol should be part of stroke prevention efforts, especially for those at higher risk."

Limitations of the study include its cross-sectional design, which looked at a single point in time rather than tracking changes over time. Detailed lifetime alcohol exposure was not available. Researchers also noted that heavy drinking was self-reported, so people may not have remembered or reported the information accurately.