Cerebral bleeding can be the consequence of several conditions :

  • Subarachnoidal haemorrhage caused by aneurismal rupture.
  • Bleeding by rupture of an arteriovenous malformation.
  • Bleeding of traumatic origin.
  • Intracerebal haemorrhage caused by arterial hypetension.

An aneurysm is an abnormal dilation of a blood vessel. The most devastating consequences of intracranial aneurysms, which often lead to severe disability or death, result from their rupture and bleeding into the space around the brain.

A major rupture is often preceded by a “warning leak” which manifests itself as a new or uncharacteristic headache. The outcome for patients treated before a catastrophic haemorrhage being much better than those treated after, the need for adequate evaluation of patients suspected of harbouring an intracranial aneurysm is of paramount importance.

Unruptured intracranial aneurysms can be detected by non-invasive measures, including magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Aneurysmal rupture can be detected by a CT scan or lumbar puncture. If an aneurysm is suspected, cerebral angiography should be performed.

Nowadays the cornerstone of therapy for intracranial aneurysms relies on a minimally invasive technique which does not require an operation, called endovascular therapy, using microcatheters to deliver coils to the site of the enlarged blood vessel. The coils occlude (close up) the aneurysm from inside the blood vessel thus avoiding an operation. Microsurgical clipping done by a surgical procedure inside the skull is still performed in some cases when endovascular treatment is not possible. The best method of securing the aneurysm is made on an individual basis after discussion between the neurosurgeon, the neurologist and the neuroradiologist. Most of the time, patients with a ruptured intracranial aneurysm should be treated as soon as possible.