Pathologic studies demonstrate tracking of blood along tissue planes and displacement of tissue more often than gross destruction. Because of this the ultimate outcome for the patient may be considerably better than indicated by the acute deficit. The clinical syndrome usually comes on over minutes to hours. Hemorrhage probably lasts only a few seconds and then stops. If not, there is immediate mortality.
Headache occurs in only a small percentage of patients.
The neurological deficit depends on the area of the brain involved. Initial therapy is directed at the control of hypertension and treatment of increased intracranial pressure and cerebral edema. Most patients with small and medium hematomas recover without surgery. Surgery may be indicated if the hematoma is large, the neurologic symptoms progress despite medical therapy, or the patient is in coma. Aneurysm Saccular aneurysms are thin-walled blisters protruding from specific arterial bifurcation sites, most commonly on the arteries of the circle of Willis at the base of the brain.