Brain haemorrhage

A brain haemorrhage is a brain bleed, where a blood vessel bursts and causes bleeding into or around the brain. This may occur as a result of a stroke or a head injury.

Dr Nash also deals with other causes of brain haemorrhage such as aneurysms, AVMs and cavernomas.

Aneurysm

A brain aneurysm is a balloon-like bulge in the wall of a blood vessel in the brain. Small ones often cause no symptoms, and may only be discovered when you’re undergoing treatment for something else. But when symptoms do occur, they may be things like problems with your peripheral vision, speech, balance or ability to think, which usually only occurs when the aneurysm has grown very large.

Only 1-2 per cent of aneurysms burst in any given year, but it is an emergency situation if one does, so if you are diagnosed with an aneurysm, every effort will be made to treat it before it reaches a critical stage.

The most frequent treatment carried out is coil embolization, where a small tube is inserted into the affected artery and miniature platinum coils are moved through the tube into the aneurysm, relieving pressure and making it less likely to rupture. More than 125,000 patients worldwide have been treated with detachable platinum coils and because it is not a very invasive procedure, many patients go home soon after the embolisation. This procedure is performed by an interventional radiologist to whom Dr Nash will refer you if this is the optimal way to manage your aneurysm.

Another treatment available is surgical clipping via a craniotomy, which involves placing a small metal clip around the base of the aneurysm to cut it off from the normal blood supply. This procedure is more invasive, so whether it can be carried out depends on the location and size of the aneurysm, and your general health. Most patients spend a longer time in hospital after a clipping procedure. This procedure will be performed by Dr Nash.

Stroke
A stoke is usually caused by the blockage of a blood vessel in the brain which cuts off blood supply to another part of the brain causing symptoms like dizziness, the inability to speak or understand, visual loss and impaired ability to move the limbs. Sometimes a stroke causes the blood vessel affected to burst, while other times the blood vessel bursts and causes a stroke. In both instances, it may be necessary to drain the bleeding to improve the outcome of the stroke. Dr Nash performs this surgery through a craniotomy which is a procedure that removes part of the skull bone in order to access the area of the brain affected. The skull bone is then put back in place.
AVM
AVM stands for arteriovenous malformation – an abnormal connection between the arteries, veins and capillaries in the brain, which form a tangled mass. Most doctors believe that AVMs form before a person is born. Only 1-3 per cent of AVMs rupture in any given year, but if one does, it can cause symptoms similar to those of a stroke. AVMs can be detected before they burst, because they can cause a wide range of symptoms such as tinnitus (ringing in the ears), numbness and headache. Some are also picked up in the course of routine scanning. Depending on their size and their location in the brain, AVMs can be treated with conservative medical therapy, surgery or radiosurgery. They can be shrunk using GammaKnife® or CyberKnife®, which is particularly useful for small AVMs deep in the brain, which are difficult to remove by conventional surgery.
Cavernoma

A cavernoma is a small cluster of abnormal blood vessels that fill up with venous blood and looks something like a blackberry. Because the blood comes from the veins rather than the arteries it is a low pressure and many people don’t have symptoms – the cavernoma may only be found in the course of a scan for something else. But if a cavernoma bleeds, it can give rise to seizures or signs like those of a small stroke. Symptoms may also come and go as the cavernoma bleeds, then the blood is reabsorbed.
Dr Nash usually treats cavernomas by excision. ie: they are cut out as this is the optimal management in most cases.