Comprehensive Management of Hemorrhagic Stroke
Hemorrhagic stroke : It occurs due to leaking or bursting of blood vessels in the brain. This results in bleeding in or around the brain. In severe cases, bleeding may cause further swelling of brain tissue. The hemorrhage stroke is of two types:
- Subarachnoid hemorrhage (SAH): The bleeding that occurs due to bursting of abnormal or weak blood vessels (aneurysm) between the layers covering the brain around the brain is referred as subarachnoid hemorrhage.
- Intracerebral hemorrhage (ICH): The bleeding into the brain due to severe high blood pressure is known as intracerebral hemorrhage.
Treatment of Hemorrhagic stroke
A hemorrhagic stroke is difficult to treat. The line of treatment specifically depends upon the
cause of bleeding. It is an emergency condition that requires close monitoring of the patient in
an intensive care unit.
The initial and emergency line of treatment for hemorrhage stroke includes:
- Ascertaining the cause of bleeding
- Controlling and measuring brain pressure
- Control of blood pressure
- Discontinuing any other medications
Ventriculostomy tube can be used to measure brain pressure and to drive out blood collected in the brain.
Surgical treatment of Hemorrhagic stroke :
Surgical treatment is often recommended to prevent or stop the bleeding inside the brain.
Surgery should be ideally done within first 48 to 72 hours following hemorrhage. But if the
patient’s condition is severe then surgery may be delayed for one or two weeks.
The various surgeries done to treat hemorrhagic stroke include:
- Aneurysm treatment : The hemorrhagic stroke that has occurred due to bursting of a weak area of an aneurysm (blood
vessel) is treated using aneurysm treatment. In this method, a clamp is placed at the base of
aneurysm under local anaesthesia. This stops bleeding and prevents re-bleeding. The
procedure requires removal of a piece of skull to locate the aneurysm within the brain tissue.
The skull piece is replaced at the end of surgery. The procedure may take several hours to
Another less harmful method commonly used is coil embolization. It involves insertion of a catheter into an artery in the groin. The catheter is guided to the vessels in the brain where aneurysm is located. The aneurysm is then filled with a tiny coil. This creates a blood clot within the coil that blocks the blood flow to the aneurysm. Hence, further leaking of blood is prevented.
- Arteriovenous malformation treatment : Significant risk of bleeding is associated with arteriovenous malformations (AVMs). Although various techniques like surgery, radiosurgery, or embolization can be done for arteriovenous malformations but the choice depends upon several factors like age of the patient, size and location of AVM and vein abnormalities.
- Decompressive craniotomy : Although decompressive craniotomy is the choice of treatment in cases where brain pressure increases due to blood clots but various factors like patient’s age, location and size of hemorrhage, medical conditions, and chances of recovery from stroke are taken into considerations before performing this procedure. It is a life threatening condition that requires opening of skull to remove blood.
Dr Manish Vaish - Neurosurgeon
Neurosurgeon NCR, Delhi
Dr. Yashpal Bundela MS Mch
Dr.Girish Rajpal MS Mch FINR
Dr. Shiwani Jain MD FNB
PDFC (Neuro-anaesthesia and Critical care)
Dr Hrishikesh Chakrabartty
Dr.Praveen Kumar MS Mch
Dr. Manish Marda MD DM