Can a secondary hemorrhage from cerebral hemorrhage be saved?

Written by Chen Ya
Geriatrics
Updated on September 16, 2024
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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.

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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.

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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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Geriatrics
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Sequelae of cerebral hemorrhage

The most common sequelae of cerebral hemorrhage is hemiplegia, which is specifically characterized by reduced muscle strength in the limbs on one side, difficulty in movement or complete immobility, often accompanied by sensory impairments on the same side, such as reduced sensation to cold, heat, pain, etc., or complete numbness. Sometimes there may also be vision loss on the affected side, as well as aphasia, headache, vertigo, and nausea.

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Written by Chen Yu Fei
Neurosurgery
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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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Written by Chen Ya
Geriatrics
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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.