Bleeding in the brain, or hemorrhagic stroke, is a life-threatening situation. It typically occurs when an aneurysm, a bulge in a blood vessel, bursts. Brain cells, starved of blood supply, immediately begin to die. Brain tissue begins to swell in response to the bleeding, which can also kill cells. The brain is unable to regenerate cells once they are destroyed, so brain functions can be lose forever due to bleeding in the brain. But there are treatments for bleeding in the brain. As long as a patient receives prompt medical attention, doctors are often able to minimize the damage and repair the burst vessel.
Blood Pressure Control
With any bleeding in the brain, doctors will immediately intervene to lower blood pressure, which slows the bleeding. According to the National Stroke Association, high blood pressure is the single most important controllable risk factor for brain hemorrhage, leading to 60 percent of hemorrhagic strokes. Patients will receive IV medications to lower blood pressure and slow the bleeding, and if they are conscious, may be sedated to keep from exerting themselves.
Surgeons are often able to repair a ruptured vessel in the brain. They may do this by attaching a tiny clip onto the neck of a brain aneurysm, cutting off blood flow to the area of the rupture. But surgery isn't an option in all cases. According to the National Institutes of Health, surgeons will determine whether to attempt a repair based on the location and size of the burst vessel, as well as the age and health of the patient.
Surgical Removal of Blood Clots
Blood pooling in the brain from a hemorrhagic stroke may form a large clot, called a hematoma, which puts pressure on brain tissue because the skull cannot grow to accommodate the added material. Doctors may choose to operate to remove a hematoma, limiting the damage. Again, location and size of the hematoma play an important role in the decision to operate. The National Institutes of Health notes that hematomas close to the brain stem are often not removed, because of the risks of surgery so close to vital, delicate brain stem structures.
A clear fluid, known as cerebral spinal fluid, or CSF, circulates through a healthy brain and spinal cord providing nutrients and removing wastes from cells. Sometimes, the swelling cause by a hemorrhagic stroke can block the normal flow of CSF, causing a buildup of pressure in part of the brain. This is a potentially life-threatening condition known as hydrocephalus. Doctors may choose to treat hydrocephalus by draining the fluid through an extra-ventricular drain, or EVD. Because an EVD provides a direct pathway from the brain to the outside of the body, it requires meticulous sterile care, and is typically removed as soon as it can be safely taken out. In rare cases, doctors will install a more permanent drainage system, known as a shunt.
Is This an Emergency?
- National Stroke Association: Hemorrhagic Stroke Fact Sheet
- National Institutes of Health: Subarachnoid Hemorrhage
- 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