How are brain hemorrhages treated?

Any type of bleeding inside the skull or brain is a medical emergency. If you or a loved one have experienced a blow to the head or have symptoms that may indicate a brain bleed, call 911. It is important to get to a hospital emergency room immediately to determine the cause of the bleeding and to begin medical treatment.

If a stroke has occurred, the cause (bleeding or blood clot) must be determined so that the appropriate treatment can be started. Prompt medical treatment can help limit damage to the brain, which will improve your chance of recovery.

Surgery may be needed in the following situations:

  • Bleeding (hemorrhage) may require immediate decompression of the brain to release pooled blood and relieve pressure. Decompression may be done through a burr hole procedure (drilling a hole in the skull to allow blood drainage), a craniectomy incision (partial removal of the skull to allow the swelling brain to expand), or a craniotomy (opening of the skull cavity).
  • A cerebral aneurysm that has not ruptured may require clipping or filling (“sealing off”) of the aneurysm through a craniotomy surgical procedure, or an angiography-type procedure to prevent a future rupture.
  • An arteriovenous malformation (AVM) that has not ruptured is treated by direct removal of the AVM through surgery, use of computer-guided radiation to close off the abnormal vessels or use of a special glue or other filler to block the blood flow from smaller blood vessels into the AVM or the vessels that supply the AVM.
  • Some brain hemorrhages do not require surgery. The decision depends on the size, cause and location of the bleed and other factors.

Other treatments may include:

  • Anti-anxiety drugs and/or medication to control blood pressure.
  • Anti-epileptic drugs for seizure control.
  • Other medications needed to control other symptoms, such as painkillers for severe headache and stool softeners to prevent constipation and straining during bowel movements.
  • Nutrients and fluids as needed. These may be given through a vein (intravenously), or a feeding tube in the stomach (gastronomy tube), especially if the patient has difficulty swallowing.

What does rehabilitation after a brain bleed entail?

The goals of long-term treatment are to help you regain the functions needed for daily living, as much and as soon as possible, and to prevent future brain hemorrhages. Rehabilitation and recovery time vary according to each person’s unique brain bleed and the extent of rehabilitation possible.

Long-term rehabilitation treatment may include:

  • Physical therapy.
  • Speech therapy or alternative forms of communication.
  • Occupational therapy.
  • Changing lifestyle habits to reduce risk of another hemorrhage. (See next question.)

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