What treatments are available for bleeding stroke?
Treatment for a bleeding stroke is determined by the original cause of the bleeding and whether the bleeding is inside the brain or in the space between the brain and the skull. The main treatment options are:
High Blood Pressure Medications
High blood pressure is the most common cause of bleeding in the brain.3 Because these leaks are often small and are deep within the brain, they are usually treated with a conservative strategy: the leaks can often heal themselves, and getting blood pressure under control using blood pressure medications can stop more leaks from happening.6
Surgery to Remove the Blood
Surgery to remove blood that has built up inside the brain and relieve pressure inside the skull is an option in rare cases, especially when there is a large amount of bleeding or if the blood has accumulated at the base of the brain and is pressing on the brain stem.6 Surgery is also an option to remove blood clots detected near the surface of the brain.
Surgery for a bleeding stroke involves opening the skull to access the area of bleeding, then draining the blood or removing the blood clot. As with any surgical procedure in the brain, risks of this surgery include damage to brain tissue or blood vessels, swelling of the brain, reaction to the anesthesia, and wound infection.
If the bleeding stroke was caused by an aneurysm, one treatment option is surgical clipping, in which a small metal clip is used to block off an aneurysm that has burst and is bleeding.7 This procedure requires opening the skull to access the area of the brain where the aneurysm is. Recovery from this surgery can take several weeks or months, and complications may include bleeding, damage to the blood vessel or brain tissue, reaction to the anesthesia, and wound infection. This procedure can also be used to seal off aneurysms that haven't burst yet, but are at risk of causing a bleeding stroke.8
Another option for strokes caused by aneurysms is endovascular coiling, a less invasive procedure in which miniature metal coils are packed into the aneurysm to stop it from bleeding.7 The coils are placed via a long, thin tube called a catheter that is inserted through an incision in the groin and guided to the aneurysm using moving x-ray images. When the coils fill up the aneurysm, they cause the blood to clot, stopping the bleeding. After endovascular coiling, the patient usually stays in the hospital 1 to 2 days (compared to 4 to 6 days with surgery), and recovery usually only takes about a week. The complications of this procedure are similar to other procedures that use catheters, and include the risk of damaging the blood vessels with the catheter, bleeding or infection where the catheter was inserted, and kidney damage from the dye used in the procedure.9
This procedure can also be used to seal off aneurysms that haven't burst yet, but are at risk of causing a bleeding stroke.8
Correction of Malformed Blood Vessels
For bleeding that is caused by blood leaking from an abnormal tangling of your blood vessels (AVMs), the treatment used depends on the size and location of the malformation. Surgery can remove a malformation that is close to the surface of the brain. For problems deeper in the brain, a catheter procedure called endovascular embolization uses a special type of glue to block the abnormal connections and stop the bleeding. Stereotactic radiosurgery uses a beam of radiation that scars the blood vessels and seals them.