Surgery - Treating Hemorrhagic Stroke: Stroke

Content provided by the Faculty of the Harvard Medical School

Surgery

There are different surgical procedures for preventing a second hemorrhage, depending on the cause of the bleeding. For strokes caused by an aneurysm, the surgeon opens the skull, clamps the base of the aneurysm to prevent another rupture, and removes the accumulated blood. For hypertensive intracerebral hemorrhages, the surgeon may remove excess blood from the hematoma, to lessen pressure. This procedure is particularly effective in people with cerebellar hemorrhage.

The timing of surgery is crucial. In the case of a ruptured berry aneurysm at the base of the brain, for example, surgery and coiling are usually performed within two days. This effectively reduces the risk of rebleeding and helps wash clotted blood away from the artery. If clotted blood remains, it can cause a condition called cerebral vasospasm.

Cerebral vasospasm

Cerebral vasospasm is the uncontrolled constriction of arteries at the base of the brain.

About one-third of people with subarachnoid hemorrhages have a cerebral vasospasm within 4–14 days. Although researchers still don't fully understand what causes vasospasm, it seems to be triggered either by substances released as a blood clot breaks down or by a clot surrounding the artery at the base of the brain and depriving the blood vessel of nutrients from spinal fluid. Vasospasm can be so severe that it impairs blood flow to the brain, causing additional damage and even death. People with a subarachnoid hemorrhage should have a CT scan done right away to detect blood clots so doctors can locate the aneurysm and predict where vasospasm may occur.

The treatment for vasospasm is not always effective. Options include administering intravenous fluids to increase blood volume, using drugs to raise blood pressure, or giving medication, such as nimodipine (Nimotop), that relaxes the muscles in vessel walls. In some cases, it may be necessary to dilate the vessel with a balloon catheter or inject medicine directly through a catheter in the artery near the vasospasm. Because of the serious risks involved, which include rupturing the artery, this procedure requires a highly skilled and experienced team of physicians.

Last updated:	September 05, 2008