Friday, December 14, 2007


Many factors dictate brain hemorrhage treatments

Bleeding anywhere in the brain is life threatening. Physics dictates that adding volume to a closed container will result in increased pressure. When blood accumulates in the skull, it puts pressure on the brain causing severe damage.

The location of the blood within the brain is often an indication of the source of hemorrhage and the cause of bleeding.

An intracerebral hemorrhage occurs when a blood vessel in the brain ruptures, resulting in bleeding within the substance of the brain. This type of brain hemorrhage is most commonly seen and causes a hemorrhagic stroke. This differs from an ischemic stroke, which is typically caused by a blocked blood vessel as opposed to leakage. It is often the result of chronic high blood pressure, malformed blood vessels, or both. A substance known as beta-amyloid is deposited in the walls of blood vessels during the normal aging process. The accumulation of beta-amyloid weakens the vessel walls, thus making intracerebral hemorrhage more likely in older people.

Sub-arachnoid hemorrhage occurs as the result of a ruptured aneurysm beneath the arachnoid tissue surrounding the brain. An aneurysm is a weakening of an arterial wall resulting in the formation of a berry-like deformity. It is very similar to a bulging bubble seen on the inner tube of a bicycle tire. Aneurysms are usually present at birth and are commonly seen as a family trait.

Subdural hemorrhage occurs beneath the dura mater or the outermost covering of the brain. It typically results from trauma to the veins bridging the subdural space.
Epidural hemorrhage occurs outside the dura mater. This type of hemorrhage is caused by trauma to the middle meningeal artery. Since it is arterial in nature, it produces a large amount of blood very quickly and many times results in sudden death.
There are different treatments for brain hemorrhage. The type of treatment depends on the location of the bleeding and the amount of blood that accumulates.

Neurosurgeons often open the skull and mechanically stop the bleeding and repair the damaged blood vessel. Recent studies have shown that in smaller hemorrhages, the risk of further injury is greater with surgery and it is best to medically support the patient. Medications lower blood pressure, shrink brain swelling, and prevent seizures. Rehabilitation in the form of intense physical, occupational, and speech therapy can lead to a full recovery for many patients.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Alessi and all of the Healthy Living columnists at

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