A cerebral hemorrhage is an internal bleeding that occurs inside the skull. In this case, the blood suddenly flows into the brain tissue and causes damage to the brain. The cause of cerebral or intracranial bleeding can be things like high blood pressure, head trauma and some other things. On the other hand, intracranial bleeding is not a stroke and is different.
Cause of cerebral hemorrhage
If blood leaks from the cerebral vessels inside the skull for any reason or flows out faster, cerebral hemorrhage occurs. In examining the cause of cerebral hemorrhage, the following are more common:
Hitting the head (hitting the head and bleeding)
High blood pressure (the cause of more than half of cerebral hemorrhages)
Occurrence of cerebral hemorrhage due to some diseases such as hemorrhagic stroke
Occurrence of disorders in blood coagulation
In some cases, anticoagulation treatments (use of drugs such as heparin and warfarin)
Inflammation of brain vessels
Use of drugs such as amphetamines
What are the common symptoms of cerebral or intracranial bleeding?
Signs and symptoms vary depending on the severity and type of intracranial bleeding and generally include the following:
Sudden and severe headache, associated with a recent blow to your head, mild and prolonged, with neck stiffness, coma, difficulty swallowing, vision problems in one or both eyes, loss of balance and coordination, dizziness, confusion and delirium, drowsiness Vomiting more than twice in 24 hours, difficulty with language skills (reading, writing, speaking, understanding), apathy and lethargy.
If cerebral hemorrhage occurs in children, it can be accompanied by the following symptoms:
swollen head
Retinal hemorrhages
vomiting
fainting
Babies younger than 12 months may have a swollen fontanel or soft spot.
Types of cerebral hemorrhage
In general, the types of cerebral or intracranial bleeding are divided into the following four categories according to the place of the accident and the membranes inside the skull:
Epidural hematoma
Subdural hematoma
Subarachnoid or subarachnoid hemorrhage
Intracerebral hemorrhage
Types of cerebral hemorrhage
Epidural bleeding
Hematoma is a state where blood accumulates in the form of a clot outside the blood vessel. An epidural hematoma has occurred when blood collects between the skull and the last covering layer of the brain.
More scientifically, epidural bleeding occurs just below the skull. One of the main reasons for the formation of this condition is a direct blow to the head, in which case the person may lose consciousness. As a result of this blow, incidents such as fracture of the skull and rupture of the main blood vessels have led to the formation of hematoma. In some cases, the severity If the impact is high, it may change the mental state.
One point that should be noted is careful examination. Usually, after a trauma, patients show complications from the trauma between a few minutes and a few hours. This time is called transparent interval. In this case, the victim may think that there is no problem, but the hematoma is getting bigger and worse. In this case, brain herniation and brain death may occur.
Subdural hematoma
The location of subdural hematoma is within the dura meningeal layer. If it happens, the patient’s headache and confusion will gradually increase. Subdural hematoma is more chronic than epidural bleeding. Rupture of blood vessels leads to the accumulation of blood under the skull, as a result of this accumulation, which may occur slowly, a subdural hematoma is formed.
The cause of subdural hematoma is different in different age groups and it occurs with fast forward head movement and sudden stop. Subdural hematoma in infants is due to non-accidental injury, in young people it is caused by a bicycle or car accident, and in the elderly, subdural hemorrhage usually occurs after a fall. Minor head trauma can also cause subdural bleeding in patients receiving anticoagulants.
If the subdural hematoma is small, it may not have any symptoms and can be treated without surgery or drainage.
But in the case that the subdural hematoma is large, it can be accompanied by lethargy or coma, unilateral pupil enlargement. When the subdural hematoma is large and isolated, it requires timely surgery and evacuation. However, the mortality rate due to it is high.
Subarachnoid hemorrhage
This type of bleeding occurs in the subarachnoid space and in case of abnormality in the venous artery. Symptoms of subarachnoid hemorrhage are severe, sudden and sharp headache with vomiting and unconsciousness. Usually, the severity of this headache is so high that the patient cannot bear the pain. The root of this type of intracranial bleeding can be related to family history and rooted in heredity. It is also common in alcoholic and substance abuse patients.
Intracerebral and intraventricular hemorrhage
If the bleeding is in the intracerebral substance, this condition is formed, which often occurs with a stroke and is more common than other hematomas. Common sites for intraventricular hemorrhage are the thalamus, cerebellum, and pons.The most obvious sign of ventricular hemorrhage is the sudden onset of nerve damage, followed by symptoms such as headache, difficulty speaking, nausea, vomiting, loss of consciousness, headache, and weakness in one part of the body. Unfortunately, between 35 and 45 percent of patients with intracerebral hemorrhage die within 30 days.
Diagnosis and treatment of cerebral hemorrhage
Causes of intracranial bleeding
Many of our habits and behavior are influential in the formation of diseases. Also, some of these factors are formed according to heredity and place of residence. Each of these factors is a risk factor that can increase the probability of contracting the disease. In general, these factors are:
family history
High alcohol consumption
smoking
Substance abuse, especially amphetamines and cocaine (increased blood pressure)
Blood coagulation
Uncontrolled blood pressure
Race, which in this case includes Asian and black.
Men are more at risk than women.
Intense physical activity
Diagnosis of cerebral hemorrhage
CTA scan or MRA is usually used to detect the presence of cerebral hemorrhage, which is often the answer.
A CT scan may not show any signs of bleeding. But if symptoms are present, your doctor may perform a lumbar puncture or spinal tap to test the fluid that is putting pressure on your spine and brain.
Each type of bleeding has a specific shape that can be seen in the CT scan:
Epidural – A convex lens that does not cross the suture lines can cross the midline
Subdural – concave lens that can cross suture lines, can cross the midline
Subarachnoid – blood in the lateral ventricles
Intracerebral – blood in the brain substance
Necessary measures during cerebral hemorrhage
If you face the symptoms of cerebral hemorrhage, keep a cool head, get help from someone to notify the medical center and take the following preventive measures yourself:
Turn the person slowly to the side so that the secretions come out of her mouth and do not cause suffocation.
Remove all objects around her that may be touched due to a seizure, away from the patient.
Any pressure on the skull should be avoided, then do not forcibly prevent the movement of the limbs during a seizure.
Avoid giving water, food and medicine to the patient separately.
Treatment of cerebral hemorrhage
In this case, the treatment is divided into two parts: emergency and complementary.
Emergency treatment:
In emergency treatment, an attempt is made to get the patient’s condition under control until they reach the hospital. For this purpose, to maintain systolic blood pressure less than 140 mm, non-venous dilators such as nicardipine are used, labetalol or osmolol.
Complementary treatment:
After visiting the hospital, especially if anesthesia or coma has occurred, steps such as tracheal intubation and sedation, administration of osmotic diuretics such as mannitol or hypertonic saline, and elevation of the head of the bed during the surgical consultation will be performed.
The drugs used are:
Steroids to Reduce Swelling
Anticoagulants to reduce clotting
Anticonvulsants
Medications to counteract the blood thinners you’ve been taking
Depending on the severity of the bleeding, draining the hematoma can lead to healing. Sometimes physical therapy or occupational therapy is needed to help you return to normal activities.
What are the complications of different types of cerebral hemorrhage?
In the event of a brain hemorrhage, any of the complications may occur and in some cases are unavoidable. Complications of cerebral hemorrhage include:
Seizure
Paralysis
Headaches
Brain development problems in children
Memory loss
Dizziness
Difficulty concentrating
What can be done to prevent cerebral hemorrhage:
It should be noted that one of the most important causes of brain hemorrhage is accidents. If you follow the precautions of the operation, you have done the best prevention. For this reason, and in order to take preventive measures, observe the following:
Always wear a helmet when riding a bike, motorcycle, skateboard, or scooter.
Always wear your seatbelt.
If you are older, try to avoid falling.
Unfortunately, one of the cases of brain hemorrhage in children is child abuse, so it is better not to remain silent and inform the relevant organs if you see them.
Living a healthy life and following a proper diet can also be very effective.
The presence of omega-3s in the diet helps the brain recover quickly.
Stop using alcohol.
Don’t smoke.
The use of any drug greatly increases the risk of brain damage, give up addiction.
Vigorous physical activity, whether it is work or exercise, is not good for the body.
It is better to control the stress and tension levels in your life.
Having a sleep routine and adequate rest also has a great impact on brain function.
What happens after a brain hemorrhage?
In case of severe brain hemorrhage, the following may occur:
If the extent of bleeding is large, there is a possibility of the patient dying or paralysis.
If the swelling is severe, surgery is recommended to prevent it from getting worse.
or if intracranial bleeding is controllable, brain surgery is not recommended.
Medication and physical therapy are used for treatment if brain function is reduced, the extent of bleeding is low, or difficulty with motor posture.
Does brain hemorrhage cause death?
Given that the symptoms of cerebral hemorrhage depend on the extent of the bleeding and its location, patients’ symptoms can range from mild limb weakness to decreased level of consciousness and death. In extensive bleeding in the cerebellar region, if there is no immediate surgery, the patient’s death is certain.
What is brain hemorrhage surgery like?
According to the types of brain hemorrhages, different surgeries are performed by neurosurgeons:
For brain hemorrhages caused by an accident and falls from heights that occur between the skull bone and the cerebral membrane, craniotomy surgery (opening the skull and draining the bleeding) is necessary to stop the bleeding.
If bleeding has occurred under the hard membrane of the brain, a craniotomy is performed due to its large extent, and in this case, the membrane must be opened to drain blood.
In bleeding inside the parenchyma of the brain where the patient is in a coma and experiencing a decrease in the level of consciousness, surgery is required.
How many hours does a brain hemorrhage operation take?
In general, the process of cerebral hemorrhage surgery includes performing anesthesia, separating the scalp, separating the bone in the desired area, accessing the bleeding site through the shortest route with a microscope, draining blood (cerebral hematoma), and at the end of the procedure, repairing the membrane, bone, and scalp.
All of these procedures may sometimes take more than 12 hours, and the patient must be under general anesthesia the entire time. The time to regain consciousness ranges from 45 minutes to one hour, during which the patient is in the recovery room.
How is bleeding absorbed?
After a brain hemorrhage, although the chances of surviving large-scale hemorrhages are very low, if the patient survives, the recovery period will take several months.
Various medications can be used to reduce the inflammation around the bleeding area so that the blood pressure is in the optimal state and the patient does not suffer from tremors. Usually, patients who are conscious should use painkillers.
During the recovery period and over time, some patients can regain some of their abilities with physical therapy, occupational therapy, and speech therapy, but most victims of brain hemorrhage will have weakness, tremors, headaches, memory impairments, vision, hearing, and touch problems for the rest of their lives.
What drug causes brain hemorrhage?
As much as medications help patients control diseases, they can cause many problems if they interact with each other or are used indiscriminately, including:
In brain hemorrhages, one of the important causes is the use of blood thinners (such as Coumadin and warfarin), which cause the brain arteries to rupture and cause brain hemorrhage.
Some prescription medications that cause high blood pressure can also cause brain hemorrhage.
Cocaine and drug use can also cause brain hemorrhage due to weakening the walls of the arteries.
Final Word on Cerebral Hemorrhage
We should know that after the occurrence of many accidents and diseases such as brain hemorrhage, home remedies or exercise cannot be used arbitrarily. If you encounter such symptoms, discuss the problem with the medical center as soon as possible.