Cerebral Hemorrhage

What is a Cerebral Hemorrhage?

The term “Cerebral Hemorrhage” refers to uncontrolled bleeding that occurs within the brain tissue or ventricles ¹. This condition results from an injury or because of a leaky or burst blood vessel. This happens when your blood vessel gets weakened and can no longer withstand the pressure of the blood flowing through it.

Several conditions like high blood pressure, atherosclerosis (plaques of fat blocks the artery), amyloid angiopathy(deposition of protein in artery walls) can weaken your blood vessel walls. The damages of blood vessels may form a condition known as aneurysms, which means bulging of the weakened areas of vessels. Another site of cerebral hemorrhage includes arteriovenous malformations, which means abnormal connections between arteries and veins that may be present at birth ².

Our brain comprises many blood vessels running through it and around it. If a blood vessel bursts inside the brain, blood can spread into the brain tissue and results in inflammation and swelling. Sometimes, this causes subarachnoid hematoma, when one of the blood vessels on the surface of the brain breaks and the blood drains between the brain and the membranes that surround it. Ultimately, these damage the brain.

Cerebral hemorrhage may occur as a result of weakened blood vessels, which can be present at birth or can occur due to processes that damage blood vessels. Additionally, a number of risk factors increase the risk to develop cerebral hemorrhage. Risk factors for cerebral hemorrhage include hypertension (high blood pressure), diabetes mellitus, hypocholesterolemia, drugs, menopause, excessive alcohol consumption, smoking, and severe migraine.

What are the most common symptoms associated with a Cerebral Hemorrhage?

Cerebral hemorrhage has an overall incidence rate of 25 per 100,000 persons every year in the world ³. The case fatality rate of cerebral hemorrhage also high (40% at 1 month and 54% at 1 year) and only 10 percent to 40 percent of survivors can achieve long-term functional independence. This condition also accounts for approximately 10-20% of all strokes in the western countries like USA, UK and Australia ⁴.

Symptoms of cerebral hemorrhage develop suddenly. This emergency condition needs treatment as early as possible to save the brain tissue, otherwise, long-term complications may arise. Common symptoms of cerebral hemorrhage include difficulties in swallowing, change in the level of consciousness, numbness or weakness, paralysis, changes in vision, seizure, headache, difficulties in thinking, talking, comprehension, etc. Sometimes, conditions become more severe and cause changes in your mental status or sudden behavioral changes such as confusion, delirium, lethargy, hallucinations, or delusions ⁵.

How do Neurosurgeons most commonly treat a Cerebral Hemorrhage?

The treatment of cerebral hemorrhage depends upon the cause of the hemorrhage along with the location and the amount of blood. Sometimes, surgery requires correcting this condition, and medications help to control the associated symptoms. Your physician will give you initial treatment first. After initial treatment, rehabilitation can help you to recover functions that lost previously. Initial treatment should include ²:

1. Medications, such as anticonvulsants to control seizures and pain relievers to increase comfort
2. Interventional radiology: This helps to treat abnormal blood vessels and helps to reduce the blood flow in the bleeding area
3. In the case of coagulopathy, physicians suggest using frozen plasma, vitamin K, protamine, or platelet transfusions
4. H2 antagonists or proton pump inhibitors helps to reduce stress and antihypertensive therapy lowers the blood pressure in acute phases for a better outcome
5. Surgery: Surgeons may perform this when the hematoma exceeds 3 cm (1 in) in diameter. Placing a catheter into the brain vasculature helps to close off or dilate blood vessels and sometimes, craniotomy performs to remove the swelling of blood vessels.

Though, the risk of death due to cerebral hemorrhage remains high when an injury occurs in the brain stem. You need to do a regular check-up if you have the risk factors of cerebral hemorrhage and consult with your doctor immediately for further advice.

References

1. An, S. J., Kim, T. J. & Yoon, B. W. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: An update. J. Stroke 19, 3–10 (2017).
2. Rincon, F. & Mayer, S. A. Intracerebral haemorrhage. Core Top. Neuroanaesth. Neurointensive Care 373, 359–368 (2011).
3. Adeoye, O. & Broderick, J. P. Advances in the management of intracerebral hemorrhage. Nat. Rev. Neurol. 6, 593–601 (2010).
4. Hostettler, I. C., Seiffge, D. J. & Werring, D. J. Intracerebral hemorrhage: An update on diagnosis and treatment. Expert Rev. Neurother. 19, 679–694 (2019).
5. Yaghi, S. et al. Hematoma expansion in spontaneous intracerebral hemorrhage: Predictors and outcome. Int. J. Neurosci. 124, 890–893 (2014).