Dr. Jarod Lee Roland, MD

Hemorrhagic strokes are particularly dangerous, as they may go undetected. For example, someone who forcefully hits his head may simply ice his wound and not seek medical treatment, unaware that blood is leaking into his brain from a ruptured vessel. When blood leaks into the brain, the blood gathers and begins to compress the brain tissue. At the same time, the damaged vessel does not deliver blood as it normally does. Since the brain cannot function without a steady supply of blood oxygen and nutrients, the brain begins to die and may cease functioning. Hemorrhagic strokes can result in impaired movement, speech, cognitive ability, and physical functioning and may even cause death.

Certain risk factors may increase one's likelihood for developing a hemorrhagic stroke:

• High blood pressure
• Bleeding disorders (such as hemophilia)
• Blood vessel abnormalities
• Brain tumor
• Liver disease
• Drug abuse

There are two types of hemorrhagic stroke: intracranial hemorrhage stroke and subarachnoid hemorrhage stroke. Intracranial hemorrhages cause bleeding inside of the brain, while subarachnoid hemorrhages happen when bleeding occurs in the region between the brain membrane and the brain. Both types of hemorrhagic strokes require immediate medical treatment, which can prevent severe and life-threatening brain damage. Signs of hemorrhagic stroke include:

• Fever
• Disorientation or confusion
• Difficulty speaking
• Difficulty walking
• Impaired vision
• Weakness in the face, legs, or arms
• Severe headaches

When someone suspected of having a stroke reaches the hospital, the patient will usually receive a CT or other scan that provides an image of the brain. The scan results can reveal clotted or leaking blood in the brain. Physical exams, neurological exams, and blood tests may also be used to check for blood clotting and sugar. Treatment generally begins immediately if a stroke is detected.

Hemorrhagic strokes are treated with blood-saving medication and surgery. For a hemorrhagic stroke caused by an aneurysm (blood vessel bulges) rupture, surgery might be performed to stem the bleeding. Another treatment is endovascular coiling, where a catheter (thin, hollow needle) is used to place a platinum wire coil at the spot of the aneurysm. The coil blocks bleeding and prevents the aneurysm from continuing to leak blood. A similar technique is stent-assisted coiling, which adds a stent (small wire-meshed tube) into the blood vessel to block the leaking opening of the aneurysm. These procedures are usually combined with blood-thickening medications. Blood transfusions may be administered if substantial blood loss has occurred.

Hemorrhagic stroke patients who may have lost some essential functions while the blood flow to their brains was obstructed may receive post-stroke rehabilitation to rebuild their physical and mental abilities. Some restorative treatments include occupational, physical, and speech therapy. Patients may also receive care from a neurologist, who can develop individual treatment plans, and rehabilitation psychologists who may help patients with their emotional, behavioral, and cognitive recovery. Some stroke patients require lengthy rehabilitation and may never fully regain function, while others may recover more quickly. While the fastest recovery improvements are usually seen in the first three or four months, rehabilitation from hemorrhagic stroke can last for years.

If someone begins to show signs of hemorrhagic stroke, contact emergency services and call 9-1-1 immediately, since blood flow must be restored as soon as possible to avoid significant brain damage. If an ambulance takes the person to the hospital, paramedics can initiate hemorrhagic stroke treatment as soon as the patient enters the ambulance, allowing for more prompt medical intervention and care.

Hydrocephalus is most often treated with an implanted device called a shunt. A shunt is a long, thin tube that is used to drain excess fluid. One end is placed within the brain. The tube runs under the skin, along the neck behind the ear, and to another part of the body where the fluid can be reabsorbed. Most often this is the abdomen, but the chest or other areas can also be used. Shunts have a valve that allows doctors to monitor and control the pressure within the brain. Insertion of a shunt is a surgical procedure that takes one to two hours. Incisions are made in the head and the abdomen, and the shunt is threaded into place before the openings are stitched closed.

In cases where hydrocephalus is caused by a blockage, a procedure called endoscopic third ventriculostomy, or ETV, may be performed. During this procedure, a surgeon makes a dime-sized hole in the skull and uses a thin tube with a camera on the end (called an endoscope) to see inside the brain. The surgeon punctures a hole in the floor of the third ventricle, a fluid-filled space within the brain. The hole provides an opening for cerebrospinal fluid to flow around the blockage, normalizing pressure. The entire procedure usually takes less than an hour and patients can often go home the following day. ETV can provide a permanent and safe alternative to a shunt, but it is only useful for patients whose hydrocephalus is caused by a blockage.