Experts at the Center for Endovascular Surgery specialize in evaluating and treating brain hemorrhage (also called cerebral hemorrhage).

Several things can cause cerebral hemorrhage, including:

• Hemorrhagic stroke due to hypertension, brain tumors, coagulopathy (patients taking antiplatelet agents or anticoagulants), arteriovenous malformations of the brain, brain aneurysms and/or cerebral amyloid angiopathy
• Subarachnoid hemorrhage caused by brain aneurysms and arteriovenous malformations of the brain
• Epidural hemorrhage due to head trauma
• Subdural hemorrhage due to head trauma (most common in older patients and those with alcoholism)
• Intraventricular hemorrhage caused by hypertension, brain aneurysms and/or arteriovenous malformations

Factors that increase the risk for brain hemorrhage include:

• Age
• High blood pressure
• Family or personal history of brain hemorrhage or weak blood vessels or any of the conditions leading to the bleeding, such as brain aneurysms and arteriovenous malformations
• Brain tumors
• Smoking
• Alcohol abuse
• use of antiplatelet and anticoagulant therapy
• Head trauma

Although in many cases a cerebral hemorrhage occurs without warning, some people do experience warning symptoms, including:

• A sudden and intense headache
• Nausea
• Vomiting
• Sudden onset of numbness
• Sudden onset of weakness
• Dizziness
• Loss of consciousness

If the physicians at the Center for Endovascular Surgery suspect a brain hemorrhage or a condition that might lead to cerebral hemorrhage, the Center's physicians will perform tests to see if they can detect such conditions. These tests might include:

• A CT (computed topography) scan, an X-ray procedure enhanced by a computer, which results in a three-dimensional view of a particular part of the body
• An MRI (magnetic resonance imaging) and MRA (magnetic resonance angiography), imaging techniques that use a magnetic field and radio waves to produce highly accurate, cross-section views of the body's interior
• A lumbar puncture (spinal tap)
• Cerebral angiography, in which X-rays are taken of the brain after a dye is injected into it through a catheter threaded through the femoral artery in the groin

Physicians at the Center for Endovascular Surgery strive to treat patients in the safest and least invasive way. The treatment of choice, if possible, is to treat the brain hemorrhage without "opening the head," using minimally invasive approaches such as endovascular embolization (coils, non-adhesive embolic agents). When brain hemorrhage cannot be treated using endovascular techniques, the neurosurgical team performs open surgery to stop the bleeding or treat the cause of brain hemorrhage or increased intracranial pressure.

Because of the emergency nature of cerebral hemorrhage, the Center's physicians work closely with the Emergency Departments of Beth Israel Medical Center in Manhattan, Beth Israel's Kings Highway Division in Brooklyn, and St. Luke's-Roosevelt Hospital Center to stabilize the patient. Patients are evaluated and transferred to Roosevelt Hospital's Neuroscience Intensive Care Unit (or Pediatric Intensive Care Unit) as rapidly as possible. Close monitoring of the patient is combined with support for the patient and their loved ones so as to explain the plan of action of the interdisciplinary team including endovascular surgeons, neurosurgeons, neuro-intensivists, stroke neurologists, pediatric intensivists, physiatrists, nurses, physician assistants, physical therapists, speech therapists and family members.