The ‘other’ type of stroke you need to know about


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Dr. Paul Saphier
Atlantic NeuroSurgical Specialists

Every 40 seconds, someone in the United States experiences a stroke. It is a top cause of adult disability and the fifth leading cause of death in the country. However, Dr. Paul Saphier, a board-certified endovascular neurosurgeon and stroke specialist at Atlantic NeuroSurgical Specialists (ANS), cautions that not all strokes are the same.

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“The vast majority of strokes, about 87 percent, are ischemic strokes, which occur when there is a blockage in a blood vessel leading to the brain. This scenario – for example, a blood clot in the brain – is what most people think of when they think about a stroke,” Dr. Saphier said. “But the ‘other’ type, hemorrhagic strokes – also called brain bleeds – are no less worthy of attention or public education.”

Q: What is a hemorrhagic stroke, or a brain bleed?

A: Strokes are broken down into two main categories: ischemic strokes, which account for 87 percent of all strokes, and hemorrhagic strokes, or brain bleeds, that represent the balance. Ischemic strokes occur when there is a blockage in a blood vessel leading to the brain, which starves that portion of the brain of oxygen. In contrast, hemorrhagic strokes (brain bleeds) occur when – for a variety of reasons – blood escapes from the blood vessels into various portions of the brain.

Q: What causes a brain bleed?

A: There can be many different reasons for a brain bleed. It can be the result of an aneurysm – a weakening in the wall of a blood vessel – which can rupture and allow blood to escape; high blood pressure, which, over time, weakens the smallest vessel; blood-thinning medication; vascular malformation, in which there is an abnormal communication between blood vessels in the brain, resulting in stress on blood vessel walls; or abnormal deposition of material into blood vessel walls. Brain bleeds are most often associated with head trauma in people younger than 50. Sometimes, no exact cause is determined.

Q: Who is most likely to experience a brain bleed? 

A: In general, the risk factors associated with hemorrhagic strokes are age (over 50), high blood pressure, high cholesterol, blood-thinning medications and family history of brain bleeds.

Q: What are the symptoms of a brain bleed?

A: Most often brain bleeds are associated with severe headaches, vomiting, altered mental status, confusion and disorientation, paralysis or weakness, issues with speaking or understanding speech, and increased lethargy or sleepiness. In severe cases, brain bleeds can lead to coma or even sudden death.

Q: What should someone do if they think they are, or a loved one is, experiencing a brain bleed?

A: Dial 911 and seek emergency medical care at the closest emergency department and/or hospital.

Q: What type of doctors treat brain bleeds?

A: Neurosurgeons, or neurological surgeons, are specialists trained to treat brain bleeding and the associated disorders of the brain’s blood vessels. Some neurosurgeons are further specialized in these disorders and not only perform traditional “open” surgeries, but also endovascular or catheter procedures as well. These surgeons are referred to as endovascular neurosurgeons. Patients should always ask physicians about their specialties/subspecialties.

Q: How are brain bleeds treated?

A: Often, the fluid must be drained to relieve pressure on the brain. Surgery may be required if there is a large collection of blood. As an alternative to open surgery, there are also new minimally invasive approaches that use sophisticated technology. This technology creates a virtual construction of the brain and, with the help of fiber-optic cameras, allows surgeons to visualize and safely navigate through the brain in real time – with less physical trauma for patients.

The root cause, if known, must also be addressed. Brain aneurysms, for example, can be repaired using traditional surgery or endovascular therapy, which treats the aneurysm using a catheter inserted near the groin that travels up to the brain. If a vascular malformation is present, this may also require surgical removal, treatment with endovascular therapies or even radiation therapy.

The exact course of treatment depends on the individual case, so patients and their caretakers should insist on reviewing all available options with their doctor before they commit to a course of action.

While everyone who has had bleeding in the brain is confronted with a life-threatening, emergency condition, patients can – and do –  make tremendous recoveries,” Dr. Saphier said. “Many patients continue to live healthy, functional and independent lives.”

For more information on innovative stroke and neurovascular treatments, visit

Atlantic NeuroSurgical Specialists (ANS) is New Jersey’s largest neurosurgical practice and one of the most advanced in the country. Since its founding in 1958, ANS has specialized in the diagnosis and treatment of disorders affecting the nervous system. For more information, visit

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