Treating Hemorrhagic Stroke

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Treatment of hemorrhagic stroke varies depending on whether the stroke is caused by bleeding between the brain and the skull (subarachnoid hemorrhage) or within the brain tissue (intracerebral hemorrhage). Both medications and surgery may be used. The goal of treatment is to repair the cause of bleeding, relieve symptoms and prevent complications such as permanent brain damage.

Medical Management of Hemorrhagic Strokes

  • Blood pressure control is very important to prevent further injury to the brain by re-bleeding or expansion of the hemorrhage.
  • One possible complication of a hemorrhage is seizure. Patients are monitored for seizure activity and are often prescribes anti-seizure medications for prevention.

Surgery for Hemorrhagic Strokes

Surgical treatments vary depending on the cause of the stroke.

  • High blood pressure (hypertension) is one of the main causes of bleeding within the brain tissue. The surgical approach is a craniotomy, where the surgeon creates an opening in the skull and gains access to the aneurysm. Then, they place a clip on the aneurysm’s opening to obstruct blood flowing into the aneurysm.
  • Arteriovenous malformations (AVMs) are abnormal connection between the arteries and veins in the brain that usually forms before birth. Treatments include:
    • Open brain surgery – Procedure to remove the abnormal connection through an opening in the skull.
    • Embolization – An alternative to open surgery, the procedure uses a catheter and then a glue-like substance to cut off blood supply. 
    • Gamma Knife Surgery – During this noninvasive procedure, radiation is aimed at the arteriovenous malformation, causing scarring and shrinkage, and reducing the risk of bleeding.
  • Aneurysms, which are balloon-like bulges in a blood vessel, are the main causes of bleeding between the brain and the skull. Surgery for aneurysms involves either surgical clipping or endovascular coiling. 
    • Clipping/open brain surgery (craniotomy) – Surgeons perform a craniotomy to create an opening in the skull and gain access to the aneurysm. Then, they place a clip on the aneurysm’s opening to obstruct blood flowing into the aneurysm. 
    • Endovascular repair (using coils/coiling and stents) – A minimally invasive technique using a catheter to reach the aneurysm and then coils to induce clotting and prevent blood flow from entering it.