Cerebral hemorrhage CT manifestations

Written by Chen Ya
Geriatrics
Updated on September 18, 2024
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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.

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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.

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Is cerebral hemorrhage dangerous?

Cerebral hemorrhage is a type of acute cerebrovascular accident and is quite dangerous. The risk associated with cerebral hemorrhage is directly related to the amount of bleeding and the location of the bleed. Generally, if it is an ordinary lobar hemorrhage and the volume of blood is less than 30 milliliters, the risk is relatively low, and conservative medical treatment may be sufficient. However, if the bleeding exceeds 30 milliliters, there is an indication for surgery. Without surgery, conservative treatment may lead to an increase in hematoma and progressive surrounding edema, which could compress the brainstem, cause brain herniation, and lead to respiratory and circulatory failure, posing a life-threatening risk. Hemorrhages in the brainstem and cerebellum are even more dangerous. The brainstem is the center of vital functions, including the centers for breathing and heart rate. Typically, a bleeding volume exceeding 5 milliliters in the brainstem can lead to patient death. Since the cerebellum is close to the brainstem and might compress it, a bleeding volume exceeding 10 milliliters in the cerebellum often warrants consideration for surgery.

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Is cerebral hemorrhage serious?

Brain hemorrhage is relatively serious. In most cases, the condition of patients with brain hemorrhage progresses quickly and worsens gradually, often leading to high rates of disability or mortality. Additionally, brain hemorrhages can affect the patient's level of consciousness, resulting in states of stupor or coma. On this basis, it is common for several complications to occur, such as significant pulmonary infections, acid-base imbalances, electrolyte disturbances, hypoproteinemia, or deep vein thrombosis in the lower limbs. These issues can easily cause patients to experience unilateral or bilateral limb paralysis, abnormal limb sensation accompanied by a decline in cognitive functions, aphasia, and other clinical manifestations.

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Early warning signs of cerebral hemorrhage

Cerebral hemorrhage is an emergency in neurology, typically presenting acutely with little to no warning signs. Patients usually experience rapid onset of symptoms including headache, nausea, vomiting, and paralysis of limbs. A detailed look at the patient's medical history may reveal some prodromal symptoms such as recent overexertion, emotional excitement, lack of rest, or constipation, which are common triggers. If a patient experiences repeated chronic headaches and general weakness, these could be the mechanical prodromal symptoms of cerebral hemorrhage. A significant fluctuation in blood pressure should also raise concerns about the possibility of a cerebral hemorrhage. Once a cerebral hemorrhage occurs, it is crucial to promptly seek hospital treatment. If the volume of the hemorrhage is substantial, it poses a life-threatening risk to the patient and surgical treatment may be necessary. If the hemorrhage is smaller, conservative treatment may suffice, focusing on bed rest, maintaining emotional stability, and administering neuroprotective medications.

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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.