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Intracerebral hemorrhage
What are the symptoms of cerebral hemorrhage?
Patients with cerebral hemorrhage typically experience sudden headaches during physical activity or emotional excitation as their initial symptom, which may be accompanied by nausea and vomiting. In severe cases, vomiting can be projectile, consisting of stomach contents. If the patient has stress ulcers leading to bleeding and erosion of the gastric mucosa, they may vomit a coffee-ground-like liquid, which is a mixture of gastric juices and blood. Additionally, patients may also exhibit disturbances in consciousness, such as drowsiness, stupor, or even coma. If the patient is conscious, one may observe hemiplegia or paralysis, sometimes accompanied by speech impairments or psychiatric symptoms. Some patients may also experience epileptic seizures.
Principles of Treatment for Cerebral Hemorrhage
For patients with cerebral hemorrhage, the main principle of treatment is to control the blood pressure in a relatively stable state. Blood pressure should not be too high or too low. If it is too low, it can easily lead to insufficient cerebral perfusion pressure, thus causing local cerebral tissue ischemia and hypoxia, leading to the occurrence of cerebral infarction. If the blood pressure is too high, it can easily exceed the regulatory function of the blood vessels, often causing secondary hemorrhage. Secondly, it is important to promptly monitor the patient's vital signs, observe the patient's consciousness, pupils, and limb movement, and timely perform a follow-up head CT scan to dynamically observe the changes in the patient's condition.
Cerebral hemorrhage CT manifestations
The CT manifestations of cerebral hemorrhage include, in the acute phase, the CT scan showing round or oval-shaped uniform high-density fresh hematoma with clear boundaries. It can determine the location, size, and shape of the hematoma, whether it has ruptured into the ventricle, and surrounding low-density edema. There are also effects of space-occupying lesions such as compression of the ventricles and brain tissue displacement, as well as obstructive hydrocephalus and other conditions where a large amount of blood in the ventricles contributes to high-density expansion. The hematoma's pressure on the surrounding brain tissue can lead to ischemia and commonly cause a characteristic ring-shaped low density due to edema around the hematoma.
How to recover from cerebral hemorrhage
The recovery from cerebral hemorrhage is divided into the acute phase and the non-acute phase. In the acute phase, if there is a large amount of bleeding and increased intracranial pressure, surgical intervention can be considered. If the bleeding is less but intracranial pressure is still high, general treatment includes managing blood pressure well, maintaining it at 140 systolic pressure, under which conditions things generally tend to be better. Additionally, controlling intracranial pressure and treatment to stop the bleeding are needed. Later stages involve anticoagulant reversal treatments and prevention of complications because infections, high blood sugar, and stress ulcers can further worsen the condition. The later stages primarily focus on rehabilitation training treatments, helping with limb and speech rehabilitation training.
Can a secondary hemorrhage from cerebral hemorrhage be saved?
Although the mortality rate for secondary hemorrhage of cerebral hemorrhage is relatively high, there is still hope for recovery if medical attention is sought in time and aggressive treatment is administered. For instance, those with large amounts of hemorrhage can undergo surgical treatment in neurosurgery, while those with smaller amounts of bleeding can receive conservative treatment. Generally, the smaller the amount of bleeding, the greater the likelihood of survival.
Causes of cerebral hemorrhage
Any cause of cerebral vascular rupture and bleeding is called cerebral hemorrhage, including traumatic cerebral hemorrhage and non-traumatic cerebral hemorrhage. Traumatic cerebral hemorrhage, as the name suggests, is caused by head trauma, while the most common cause of non-traumatic cerebral hemorrhage is hypertension. Under the long-term impact of high blood pressure and high blood flow, numerous microaneurysms form in the brain's blood vessels. When blood pressure suddenly increases under certain conditions, these microaneurysms may rupture and bleed. The second most common cause is cerebral amyloid angiopathy, where blood vessels become aged, brittle, and weak, leading to rupture and bleeding. The third most common cause includes intracranial aneurysms and vascular malformations, which also partly cause hemorrhage. The fourth most common cause involves intracranial tumors, meningiomas, melanomas, and others. The fifth most common cause is related to hematological disorders, such as leukemia and deficiencies in clotting factors. Lastly, another cause is the prolonged use of anticoagulant and antiplatelet medications, which also contribute to cerebral hemorrhage.
Does cerebral hemorrhage have a genetic basis?
Cerebral hemorrhage is not hereditary and is not a genetic disease; it is a type of acute cerebrovascular disease. Its occurrence is related to risk factors of cerebrovascular disease, and some risk factors may be related to genetics. Therefore, having a family history of cerebral hemorrhage is considered one of the factors that can increase the incidence rate of cerebral hemorrhage in patients. For example, if a patient's parents have hypertension, diabetes, or hyperlipidemia, these risk factors can significantly increase the likelihood that the patient will also develop these conditions as they age. Long-term hypertension, diabetes, and hyperlipidemia can lead to arterial wall hardening, sometimes resulting in hyaline degeneration. When blood pressure fluctuates, it can easily form microaneurysms that rupture and bleed, thus causing cerebral hemorrhage. Therefore, although cerebral hemorrhage itself is not hereditary, hereditary-related conditions such as hypertension and diabetes might lead to its occurrence.
Complications of Cerebral Hemorrhage
The main complications of cerebral hemorrhage are infections or fever, especially aspiration pneumonia, which is quite common. The second complication is hyperglycemia. The third is stress ulcers and gastrointestinal bleeding. The fourth complication involves cardiac issues, as patients with cerebral hemorrhage are prone to neurogenic cardiac damage. Another complication is epilepsy; patients with lobar hemorrhage are likely to experience recurrent seizures. Additionally, there is also central fever.
Symptoms of cerebral hemorrhage
For patients with cerebral hemorrhage, the specific symptoms that appear depend on the location and amount of the bleed. For example, if the bleeding is in an important area for motor function, such as bilateral bleeding in the basal ganglia region, it often leads to contralateral hemiplegia in the patient, and is likely to be accompanied by abnormal sensations in the affected limbs. Additionally, if the bleeding is located in the language function area, the patient may exhibit impaired language functions, such as speech disorders, slurred speech, and difficulty speaking. Furthermore, conditions such as anomia, motor aphasia, or mixed aphasia may also occur.
How is cerebral hemorrhage treated?
The treatment for brain hydrocephalus includes conservative medical treatment and surgical intervention. Conservative medical treatment is primarily for patients with a lesser amount of bleeding, using methods such as hemostasis, brain protection, dehydration to reduce intracranial pressure, and maintaining electrolyte balance for symptomatic support treatment. For bedridden patients, it's also necessary to prevent and treat various complications such as pulmonary infections, urinary system infections, and venous thrombosis. Surgical treatment is mainly for patients with a larger volume of bleeding, approximately 30mL of cerebrospinal fluid bleeding, cerebellar bleeding over 10mL, or cerebellar bleeding less than 10mL but causing brainstem compression. Patients with hydrocephalus should actively consider surgery to remove the hematoma. The decision to perform decompressive craniectomy is based on preoperative and intraoperative findings. In some cases, where the brain compression is not severe, or in elderly patients who have poor tolerance for surgery, minimally invasive surgery to remove the hematoma may be considered.