Doctors use the term "brain hemorrhage" to describe bleeding in, or around, the brain. The bleeding kills some brain cells and can trigger swelling in the brain tissue. Swelling, by compressing the brain, can kill or damage cells even in parts of the brain far from the bleeding. Prompt treatment is essential to quality of life. Treatment for brain hemorrhage depends largely on the source of the bleeding. Whenever possible, doctors will stop the bleeding and support the efforts the patient's own body makes to recover from the damage.
Blood Pressure Control
Many brain hemorrhages can be traced to high blood pressure, or hypertension. The National Stroke Association calls high blood pressure "the most important controllable risk factor" in preventing brain hemorrhage. (See Reference 1) The first line of treatment in hemorrhages is controlling the blood pressure through intravenous medications, which will help control the bleeding.
Aneurysm Treatment
An aneurysm is a weakness in an artery wall that becomes a stretched, bulging sac. Many brain hemorrhages are triggered when an aneurysm ruptures. If the patient's condition allows, surgeons will attempt to repair a ruptured aneurysm. The National Institutes of Health explain, "If the patient is critically ill, surgery may have to wait until the person is more stable. Surgery may involve a craniotomy (cutting a hole in the skull) and aneurysm clipping, which closes the aneurysm, or endovascular coiling." Endovascular coiling is a procedure in which surgeons enter the vessels through groin area with a guide and obstruct the aneurysm with a tiny metal coil. The decision on whether to do surgery or endovascular coiling depends on where the aneurysm is located.
Treatment of Blood Vessel Abnormalities
Some types of hemorrhage are caused by a malformation in the brain's blood vessels. Such conditions are very rare; the American Stroke Association (ASA) estimates that about one in 200 to 500 people may have abnormal tangles of blood vessels in the brain, many of which may never be detected. The patient often isn't aware of this until she has a brain hemorrhage, and doctors will perform surgery to repair the blood vessels as quickly as possible. The ASA explains that surgeons will "insert small tubes (catheters) inside the blood vessel to block off the abnormal connections."
Surgical evacuation of blood clots
Sometimes, bleeding in the brain causes a large hematoma--or blood clot--to form, which puts pressure on the brain and has to be removed. The National Institutes of Health explain, "The outcome of the surgery depends on the source, severity, and location of the problem." In some cases, doctors elect to leave the clot in place because it is in a location, such as the brain stem, where the risks would outweigh the benefits of removing the clot.
Drainage
There are four fluid-filled cavities, or ventricles, inside the brain. When a patient suffers a brain hemorrhage, ventricles can become swollen with too much fluid. Surgeons may place an extra-ventricular drain (EVD) into the brain in order to drain the bloody fluid that is putting pressure on the brain. EVDs are used only for short periods of time; because they provide a direct line into the brain, they are very vulnerable to infection and require meticulous sterile technique.
More rarely, if a patient still needs fluid drained from the brain after a period of time--usually about two weeks--doctors may place another, more permanent type of drainage called a ventriculoperitoneal shunt. This mechanism drains fluid from the brain into a space in the abdomen called the peritoneal cavity, where the blood vessels absorb the drained fluid. It does not carry the risk of infection an EVD does because it is a closed system, but it is major surgery and therefore not performed unless doctors are absolutely certain the patient needs permanent drainage.
References
- National Stroke Association: Hemorrhagic Stroke Fact Sheet
- National Institutes of Health: Subarachnoid Hemorrhage
- American Stroke Assocation: What is an Arteriovenous Malformation (AVM)?
- National Institutes of Health: Before and After Hematoma Repair
- National Institutes of Health: Conversion of External Ventricular Drains to Ventriculoperitoneal Shunts After Aneurysmal Subarachnoid Hemorrhage
