Deciding Between Open Brain Surgery Or Gamma Knife

I'll never forget "the day". February 17, 2012.  I was set up to have Gamma Knife surgery three weeks after my diagnosis and it was all happening so fast. My Neurosurgeon specifically told me not to Google my condition and if my readers know me at all, they know I already did that weeks ago. Today, I realize he was only trying to help me. He didn't want me to get freaked out and end up canceling the surgery. I almost did, because I was honestly, freaked the hell out.

At that time, it was very difficult to find credible information regarding arteriovenous malformations, unless it was some medical journal or study that had so much medical terminology you needed a dictionary to understand it all. There was one very awesome support group, Ben's Friends that I had found. While Ben's Friends focuses on many rare diseases and illnesses, I did find an incredible library of information, support, and guidance from other AVM survivors. They changed their website and my account was never carried over, so I'm no longer a member. But I still support them whole-heartedly and will continue to refer other survivors to that organization.

I had two options, open brain surgery or radiosurgery. Both were equally frightening, to say the least, it was either have my skull opened up or undergo a massive amount of radiation. The radiation would be very a similar recovery as a cancer patient would undergo, while the open brain surgery may cause more deficit, a longer recovery time, but instant results as the AVM would have been removed entirely. With radiosurgery, I was informed I would expect to see results within 5 years of my surgery. It seemed to be a less invasive process for me so that was the option I went with. I was a working mother, supporting two children, and I had just entered into a business with my fiance. I didn't understand at that point in time how much this would affect my life. I thought that just because it was an outpatient process, that I would be back to work in no time, back to my daily cycling routine with my fiance and children, back to being the soccer mom, housewife, and caretaker of my family. But I guess I didn't fully understand yet just how serious this diagnosis was.

My neurosurgeon was very stern during our pre-op appointment. He literally sat directly in front of me on his stool, looking straight into my eyes as he was telling me what to expect from this surgery. He revealed I had an intracranial vascular malformation located on the left occipital-parietal temporal lobe. The occipital lobe is primarily responsible for vision. The temporal lobe processes memories, integrating them with sensations of taste, sound, sight, and touch. Damage to the left parietal lobe includes right-left confusion, difficulty with writing (agraphia) and difficulty with mathematics (acalculia). It can also produce disorders of language (aphasia) and the inability to perceive objects normally (agnosia). Special deficits (primarily to memory and personality) can occur if there is damage to the area between the parietal and temporal lobes. Left parietal-temporal lesions can affect verbal memory and the ability to recall strings of digits. While it didn't for me, it can also result in what is called "Gerstmann's Syndrome." I was also warned that aggravating this part of my brain could cause sexual dysfunction, emotional distress, and risk of seizures.

Today, I am able to write about my surgery, the feelings, the emotions, the fear, the relief of opening my eyes again after the anesthesia wore off. Today, I am able to inspire others with my story. Today, I can be thankful if just one person says, "Hey, me too!" while reading one of the posts, and they are able to still press on in life and keep fighting another day. It is still so difficult to process and look back on. I developed PTSD over the entire ordeal, not saying you will, but I did. I can't look back on the surgery itself without feeling overwhelming anxiety and dread and fear.

The goals of Gamma Knife radiosurgery are to:

1. Precisely locate the target (tumor, lesion)
2. Hold the target still
3. Accurately aim the 192 radiation beams at the target
4. Deliver radiation at the specified dose that conforms to the shape of the tumor

All while you are pinned to the table with a head frame. Ah, yes. Very frightening indeed. All I can remember from the Gamma Knife surgery itself, (I had an  MRI and Angiogram before heading to surgery), is the bright light inside the machine which looked like it was outlined in foil, and it was so bright. I call it the Easy-Bake Oven. Grade-A science experiment.

It was a lot to process. And it has taken all but seven years after the initial surgery to fully understand everything I had endured. Looking back on it all, nothing is the same. If you are reading this while opting for the treatment of an AVM, please, do not be discouraged. PLEASE have the treatment or surgery. Your health should be your main priority. I sometimes find myself saying, "I wish I never had the surgery, I wish I would have opted out" because of all the hardship I have endured. But then again, I know that the other option was death, and ultimately leaving my children alone in this world without a mother. A family without a daughter, sister, aunt or cousin. A husband without his wife. That was not an option for me. And it shouldn't be for you.

My First Angiogram Experience

I don't know about you, but angiograms scare the heck out of me. But then again, I am afraid of everything. If your doctor ordered an angiogram, please have it done because if I can do it, anyone can do it.

What To Expect

The angiogram room is extremely cold, has tons of hi-tech gadgets, a cath lab, monitors and lots of fuss! It truly is straight out of a sci-fi movie. A catheter is inserted into an artery in the leg or arm through a small incision in the skin. It is an uncomfortable feeling upon insertion and removal I must admit. But it doesn't last long. Using x-ray guidance, the catheter is navigated to the area being examined. Once there, a contrast dye is injected through the tube and images are captured using x-rays.

Take a peek at this short video which explains what to expect during your angiogram:

The halo was the most uncomfortable part of the entire procedure for me. I'm a person who fidgets a lot and I don't like feelings of helplessness. This was definitely one of those moments for me. They screw this contraption to your head and attach it to the table.

Yes, your head is literally pinned to the table and you cannot move. They will give you a sedative to help make this process a little more bearable. I have had four angiograms and all I can say is that I will never get used to my head being put in a cage and pinned to a table. But...that's just me. Did you ever see "The Jackal" from the movie Thirteen Ghosts?

Speaking of ghosts, the side effects of the drugs may give you hallucinations. Imagine lying there on the operating table and suddenly finding yourself floating inside your garage at home? I remember hovering above my car looking at paint buckets lined up in front of my garage door. Was my subconscious telling me that I needed to finally put the paint to use that I bought six months prior? Perhaps. Meanwhile, I'm just floating around in my garage, like how did I get here? I asked the neuro-team, "Why are we in my garage? How did you get me home so fast? Are we painting my house now?" And they just laughed and laughed.

Did you have a hallucination while undergoing your angiogram? I love hearing about these moments. Some of us have some really good ones! Feel free to share in the comments below!

Arteriovenous Malformation Diagnosis - The Day My Life Changed Forever

I remember it like it was yesterday, January 3rd, 2012. For a little over a week, my PCP left several voicemail messages after I had an MRI to assess a concussion I sustained the previous summer. The messages were vague but marked urgent. I had an MRI the month before and nothing was found so I didn't think anything of it. But this MRI was different because it was ordered with contrast, something my PCP had to literally fight my insurance company to cover.

And before I proceed, let me stress the addition of the contrast made ALL the difference in my diagnosis. Over the course of a decade, I received countless MRIs to assess the source of my chronic migraine, neck pain and dizziness. Not one of them revealed anything. Add contrast, and it's like watching invisible ink appear before your eyes. My advice, DEMAND IT.

At approximately 6:30pm, my PCP and I finally connected on the telephone. And I then I heard the words that no one wants to hear, "You have a brain tumor".  The good news? The tumor was benign. The bad news? It was an arteriovenous malformation located on my occipital-temporal lobe. They also found another 7cm benign tumor in my cervical spine called a hemangioma, running from my C3 to C4. Inoperable, but the doctors were certain that it was the brain tumor that was causing all of my symptoms. They wanted to handle that before moving on to the spinal tumor. I was urged to see a neurosurgeon within the week.  The appointment was already set, my medical records were already sent, all I had to do was get myself to the appointment. I didn't quite understand the diagnosis so I proceeded to tell him I had to work the day of the appointment and couldn't make it.

He said, "I don't think you understand the severity of the situation."

I said, "Wow doc, you sound pretty serious. You're scaring me."

He answered, "You have a 4.6mm arteriovenous malformation on the occipital-temporal lobe of your brain. It is severe and can cause a massive stroke at any moment. You are 68% risk of a massive stroke and if left untreated, could kill you. You need to undergo brain surgery as soon as possible." At that moment, I had dropped to my knees beside my bed in shock.

My doctor's words faded off as fear and anxiety took over my thoughts for a few moments. Brain surgery? I have to have brain surgery? What will happen to my children if something goes wrong? What IF something goes wrong? Are they going to cut my skull open? Will I be able to walk and talk afterward? I eventually confirmed the appointment with the neurosurgeon and ended the call. Then, I kneeled and prayed silently for a few moments.  I couldn't speak. I couldn't breathe. My entire body felt hot and I could no longer see past my tears.

It took me a while before I could answer my partner's pleas to tell him what was going on. I almost forgot for a moment that he was sitting on the bed hearing only half of the conversation. What would happen to us? Would he stand by me? What if I end up in a wheelchair? Then I thought about my two sons and what would happen to them. Their biological father was not in the picture. What would happen to them if I died or suffered a massive stroke? How do I tell them that mom needs to have brain surgery and could quite possibly die? What exactly is an arteriovenous malformation anyway? What is a hemangioma?

I... could... not... breathe.

Only those who have been diagnosed with a possible death sentence can understand the overwhelming fear and onslaught of emotions that pour into your mind when you hear that kind of news. It's like drowning with a 100-ton weight tied to your chest. When they say your life flashes before your eyes, they are right. I don't think I slept that night. Or any night since. And this was 8 years ago.

Looking back at this moment as I write this today is very difficult. It was the day my life changed forever. Nothing is the same today as it was back then. When I say everything changed, I mean EVERYTHING has changed. If you stay tuned to my blog, you will learn how my life has changed throughout my diagnosis, recovery, and healing. This is my survival story as an AVM Warrior.

Do you remember the day you were diagnosed? Feel free to share in the comments below.

What Is a Hemangioma? 
Spinal hemangiomas are benign tumors that are most commonly seen in the mid-back (thoracic) and lower back (lumbar). Hemangiomas most often appear in adults between the ages of 30 and 50. They are very common and occur in approximately 10 percent of the world's population. Source: UPMC

Are hemangiomas on the spine dangerous?
Symptoms vary depending on the size and location of the tumor; most hemangiomas cause no symptoms at all. Among symptomatic hemangiomas, the most common symptom is pain at the tumor site, usually in the back. Hemangiomas may also bleed, causing a hemorrhage that can expand and compress the nerves or spinal cord. Source: The Spine Hospital

What is an Arteriovenous Malformation? What is a brain AVM?
Normally, arteries carry blood containing oxygen from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. When an arteriovenous malformation (AVM) occurs, a tangle of blood vessels in the brain bypasses normal brain tissue and directly diverts blood from the arteries to the veins. Source: American Stroke Association

What are the symptoms of a brain AVM?
Symptoms may vary depending on where the AVM is located:

• More than 50% of patients with an AVM have an intracranial hemorrhage.

• Among AVM patients, 20 to 25% have focal or generalized seizures.

• Patients may have localized pain in the head due to increased blood flow around an AVM.

• 15% may have difficulty with movement, speech, and vision.

Source: American Stroke Association

Gamma Knife Surgery - One of the Most Effective Solutions for Treating Brain Abnormalities

Recognized as stereotactic radiosurgery, Gamma Knife Surgery is one of the most effective treatment solutions to many brain abnormalities which were earlier considered untreatable. It is effective both in terms of the time it takes for the treatment and the cost.

Stereotactic Surgery is a highly precise form of radiation therapy used for treating tumors and other brain diseases. It is an advanced treatment procedure that is performed without marking an incision on the brain tissue. Gamma Knife is completely a non-invasive technique and provides doctors to operate on the brain lesions without giving any incisions.

The treatment procedure comprises a machine that directs the gamma radiations to a focused area of a brain and destroys the diseased tissue without affecting the healthy tissue. 192 highly precise beams of gamma radiations are directed through a protective helmet to destroy only the diseased tissue.

Who should have Gamma Knife Surgery?

Gamma Knife is effective in treating a wide range of brain abnormalities. Gamma Knife has proved to be an effective treatment for patients who have abnormal Arteriovenous Malformations, Trigeminal Neuralgia, Tumors, and Parkinson's Disease.

Conditions such as AVM in which there are abnormal tangles of blood vessels in the brain can bleed causing seizures and hemorrhagic stroke, the surgery is highly effective. Also, the condition called Trigeminal neuralgia in which there occurs pain around the cranial nerves near the base of the brain. This pain tends to radiate out to pressure points in the face making the condition unbearable for some patients. In such conditions the surgery proves to be very relieving.

Evidence has shown that it can stop tumors from growing in 90 percent of cases. It also helps tumors to shrink in the majority of the cases. Benign tumors such as acoustic neuromas and malignant tumors that have spread can also be effectively treated.

The Treatment Procedure

Precisely, the treatment procedure involves the following steps:

• Application of the Stereotactic frame
• Image acquisition
• Planning of the dosage and
• Radiation delivery

The key component in a gamma Knife Surgery is a Stereotactic Head Frame which is a tool that allows the physician to locate the tumor or diseased tissue and perform treatment on the same. The Headframe is attached to the patient's head with screws so as to ensure that the radiation beams are targeted precisely. It also prevents any unwanted movements of the head during the treatment procedure so that only the targeted brain areas receive radiations.

After the head frame is in place, the tumor, brain lesion or abnormality is examined by CT or MRI to precisely locate its location, size, and shape. An angiogram may also be required for treating a blood vessel abnormality. The markers on the head frame and the images taken help the physician to plan out the treatment procedure for the lesion. On completion of the treatment plan, the patient is laid down on the treatment table with the head frame attached to the helmet. The gamma rays are irradiated and the abnormal tissue is damaged saving the surrounding healthy tissues.

The Increased Survival Rate with Gamma Knife

Initially considered to be a palliative treatment procedure, which was supposed to improve the symptoms only, Gamma Knife has actually proved to be effective in improving survival rates among the patients. There has been evidence which prove that patients treated with Gamma Knife survive for years.

Advantages of Gamma Knife Surgery

• More accurate treatment
• Faster treatment and time
• Greater patient comfort
• The lesion being treated receives a high dose of radiation with minimum risk to nearby tissue and structures.
• No anesthesia
• Surgery without an incision
• Lower costs than conventional brain surgery
• Minimal discomfort
• The ability to resume normal activities sooner
• The absence of an incision eliminates the risk of hemorrhage and infection.

When Strokes Happen To Young People

We tend to think of strokes as something that happens in old people. It would be more accurate to say "older" because the cut-off is about age 55. Strokes do occur more often in adults 55 and older. But, while strokes are decreasing among older people, the numbers are rising in those aged 20 to 54. In a recently published study, the percentage of strokes in adults younger than 55 rose from 13% in 1993 to 19% in 2005. That 6% difference may not seem like much, but in real numbers it means an additional 47,700 relatively young people having a stroke each year. As a result, the average age of people in the study had their first stroke fell from 71 in 1993 to 69 in 2005.

Consider this... according to the American Stroke Association, 795,000 Americans suffer strokes annually. That means that in 2005 about 151,050 of those strokes occurred in someone between the ages of 20 and 54. Why is this number rising?

One reason is that as medical technology improves, we are able to diagnose more strokes. Sometimes a person may only have a vague sense of not feeling well. In the past, a doctor asked a lot of questions and then examined you from head to foot. He or she determined what was wrong with you and, more often than not, was right. But a vague sensation of not feeling well and a small stroke with a normal examination might be very difficult to diagnose. Nowadays a doctor asks questions and does an examination but now we have CT scans and MRIs. We order a brain CT in someone with that vague feeling and see a stroke, the place where brain cells are injured, dying, or dead. That is a patient whose stroke might not have been diagnosed before CT scans were available. So our new equipment helps us find more strokes. Unfortunately, that is only a small part of the answer. There really are more strokes occurring in younger adults. But why?

We take it for granted that young people are healthy. Their bodies have not had time to develop real problems and so, when a stroke occurs, it must mean that something is very wrong. In adults younger than 45, trauma is the most common cause of stroke. It accounts for about 22% of strokes in this age group. With hemorrhagic strokes, where there is a blood vessel rupture and bleeding, the second most likely cause is arteriovenous malformation. This is an abnormal collection of arteries and veins that a person is born with. Lupus, certain cancers, illicit drugs like ecstasy, cocaine and amphetamines, some blood diseases including sickle cell disease and thrombocytopenia. These are just a few of the conditions that can increase the risk of stroke in the young. Women can have strokes associated with birth control pills. About 5% of strokes in young women occur after having a baby.

Strokes in young people can also be caused by the same factors that cause strokes in older adults. And that is the problem. The number of strokes in young adults is increasing because people are developing those stroke risk factors at younger ages. More young adults and even children are overweight. Some are obese. Many have high blood pressure and diabetes. Increasing numbers have high cholesterol and smoke cigarettes. Most strokes occur after someone has had those risk factors for many years. These traditional stroke risk factors are present at earlier ages and so, the consequences are occurring at younger ages.

Smoking is a very important and modifiable risk factor. It is responsible for a higher percentage of strokes in young adults than in older adults. With all that we've learned about smoking and its contribution to cancer, heart attacks, lung diseases, etc. why does anyone take up this habit? How can anyone afford it?

Young adults are also more likely to be involved in other risky behaviors that increase stroke risk:

• Rough contact sports that result in head and neck injuries
• Motor vehicle accidents including motorcycles, ATVs, etc.
• Heavy alcohol use
• Illicit drugs
• The misuse of legal drugs like caffeine and pseudoephedrine found in over-the-counter products
• Illegal anabolic steroids

Many doctors are seeing younger stroke patients. And more of them. This is bad news for many reasons. Younger brains may recover better after a stroke, but there may still be significant permanent damage. Think about this. Having a stroke is awful at any age. But an 80-year-old who has a stroke is probably retired. Their children are likely to be adults. Maybe that person now has to live in a nursing home. How long might that be? Five years? Ten? A 45-year-old, paralyzed for the rest of his or her life, may be unable to ever return to work and forced to live in a nursing home for decades. Their children are younger and more likely to still be living at home.

How old are you? What were you doing at age 45? If you're younger, what do you see yourself doing in the future? Most 45-year-olds are working, raising kids, taking care of their homes. The activities we all take for granted like playing with our children, going out with friends, shopping, riding a bicycle, hiking, skiing, could become suddenly impossible.

Young people often think of themselves as immune and indestructible. Many do not see doctors because they feel fine and do not think anything serious could happen to them. Poor lifestyle changes may not kill you today, but they have a way of catching up with you later. No matter how old or young you are, do these things:

• Stop smoking!
• See your doctor. Identify your stroke risk factors and start working on them.
• While seeing the doctor get treatment for any medical conditions you have.
• Eat a healthy diet. Try the Mediterranean Diet.
• Achieve and maintain your proper weight. For many of us, that means losing weight.
• Exercise regularly.
• Limit your alcohol intake.
• Avoid sports and other activities associated with head and neck injuries. If you can't avoid the activity, use the proper safety equipment.
• Avoid illicit drugs.
• Share this information with a young adult today. Prevention is the key!

Every day... say NO to stroke!

Anomalies in the Cerebrospinal System

Arteriovenous malformation (AVM), Secondary subarachnoid hemorrhage and Venous thrombosis are forms of Cerebrovascular anomalies. The pathogenesis of the first two aforementioned diseases is the occurrence of a cerebral hemorrhage, entering the subarachnoid space through the surface or the ventricles. While in Venous thrombosis, simple cerebral venous occlusion is the main cause.

Arteriovenous malformation (AVM)
These developmental anomalies consist of abnormal communications between the arterial and venous systems resulting in a cluster of dilated vessels. They vary in size from a few millimeters to huge masses lying in the cortex or white matter, usually in the posterior half of the cerebral hemispheres. They usually become symptomatic in the second or third decade. They present initially as subarachnoid hemorrhage, focal epilepsy, vascular headaches, hemiparesis or any focal neurological deficit. The combination of epilepsy with subarachnoid hemorrhage should suggest this possibility. X-ray skull may reveal abnormal venous channels with crescentic linear calcification. Arteriography delineates the abnormal vessels. Surgical treatment includes artificial embolization of the feeding vessels, ligation of feeding arteries, and resection of the AVM.

Secondary subarachnoid hemorrhage
This occurs when blood from cerebral hemorrhage enters the subarachnoid space through the surface of the ventricles. Other less common causes of subarachnoid hemorrhage include malignant tumors, trauma, bleeding disorders like thrombocytopenia, purpura and hemophilia and hemorrhagic meningitis. In these cases, the clinical evidence of the underlying disorder will be evident.

Venous thrombosis
This is either secondary to bacterial thrombophlebitis or due to simple cerebral venous occlusion (Phlebothrombosis). Intracranial thrombophlebitis is usually secondary to infections in the middle ear, paranasal sinuses, mastoids or skin over the face. The lateral sinuses, cavernous sinuses, and superior longitudinal sinus are commonly involved. In lateral sinus are commonly involved. In lateral sinus, thrombosis, the infection spreads to involve the jugular bulb to give rise to the jugular foramen syndrome with paralysis of IX, X, XI cranial nerves. In such patients, compression of the ipsilateral jugular vein fails to produce a rise of CSF pressure while doing the Queckenstedt's test, although the test is normal if the other jugular vein is compressed.

Cavernous sinus thrombosis is usually secondary to infections of the ethmoid or maxillary sinuses or the skin around the eyes and nose. The clinical features include high-grade fever, chemosis of the conjunctiva, proptosis, and edema of the ipsilateral eyelid. Later the fundus shows papilledema with retinal hemorrhage and there is involvement of the third, fourth, sixth and ophthalmic division of the fifth cranial nerves. Within a few days, the infection spreads to the other cavernous sinus through the interconnecting vessels. Sooner or later meningeal infection supervenes and meningitis develops.

In superior longitudinal sinus occlusion, symptoms start with unilateral convulsion and hemiplegia. Subsequently, when the occlusion spreads to involve the superior cerebral veins of the opposite side, it produces paraplegia. In all these instances, high-grade fever and toxemia are present. Treatment consists of a high dose of appropriate antibiotics and general measures to prevent cerebral edema and convulsions. Once the infection is controlled, the focus of infection in the offending ear or sinus should be tackled surgically to prevent a recurrence.

Sometimes, even in the absence of intracranial infection, occlusion of the superior sagittal sinus or lateral sinus develops with the rise of intracranial tension. The predisposing causes include postpartum and postoperative states, congenital cyanotic heart disease, polycythemia vera, and sickle cell disease. A stroke occurring in the background of such a clinical setting is suggestive of venous thrombosis. Venous thrombosis evolves more slowly and it has a greater epileptogenic potential than arterial occlusion. There is a great tendency to develop hemorrhagic infarction. The treatment includes correction of the basic disease, reduction of brain edema, antiepileptic medication, and treatment of infection if present.

Hemorrhagic Stroke

A hemorrhagic stroke is a drastic form of brain stroke. The public should find ways to be aware of this condition. It can abruptly affect anyone. The information about a stroke should always be focused on its symptoms, causes, risk factors, diagnoses, complications, and treatments. Hemorrhagic stroke concerns the brain. This organ has several protective layers. The major protective layers of the brain consisting of the dura mater and the skull. At birth, the suture lines of the skull override with each other. The skull completely closes as a person grows older which enables the brain cavity to expand to its normal volume and standard pressure.

Hemorrhagic stroke occurs when there is a seeping of blood from the tissues or the blood vessels. Blood that seeps out from its origin causes irritation of the brain's tissues and the swelling of the brain's structures. The blood coming from these sources accumulates and forms a hematoma. Since the normal structure of the brain cavity does not include a hematoma, the intracranial pressure will increase. This is due to the pressure the hematoma causes on the brain tissues which can further cause serious damage.

There are various types of hemorrhagic stroke according to the site where bleeding occurs. The bleeding can happen inside the brain matter, termed as intracerebral hemorrhage. Intracranial aneurysms are the bulging of weak walls of the arteries that can rupture at any point in a person's life. The rupture can occur most specifically when a person is at a heightened emotional state and a stressful event.

However, the weakness of the arteries may not just result from previous diseases like hypertension. It also may be caused by congenital malformations like arteriovenous malformations. This condition causes the entanglement of arteries and veins inside the brain. The reason for the malfunctions of the capillary beds is due to the entanglement within the vessels. The last type of hemorrhagic stroke is subarachnoid bleeding. It is the most fatal form of stroke because it involves the artery which is considered to be the main blood supply to the brain.

The symptoms of stroke, specifically for hemorrhagic stroke, comprise various manifestations depending on the location of the bleeding and the amount of damage. The most typical report of a patient who experiences this condition is a headache. A wide-range physical and psychological assessment will reveal the level of the neurological dysfunctions that occurred. There are instances that the symptoms exhibited by the patients are just side effects of the treatment regimen given to them. The risk factors that are associated with the occurrence of stroke are gender, age, and ethnicity.

This is an emergency situation. The diagnosis of its incidence is very important to determine the appropriate treatment for the patient. It entails a number of high-quality screening examinations. These screening tests are composed of imagery tests, electrical activity tests, and blood flow tests. Complications may also arise during these conditions due to hypoxia such as seizure, cerebral vasospasm, increased intracranial pressure, and systemic high blood pressure. Treatments for this condition are diverse. The treatments should be performed immediately to avert fatal damage or sudden death of the patient. The management of hemorrhagic stroke uses a combined approach of utilizing medications and undergoing surgical interventions.