How is cerebral hemorrhage treated?

Written by Jiang Fang Shuai
Neurosurgery
Updated on September 12, 2024
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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.

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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.

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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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What causes cerebral hemorrhage?

Brain hemorrhage is a common problem that can be caused by many phenomena. The most common causes include hypertension and arteriosclerosis, which can lead to the rupture of blood vessels and consequently brain hemorrhage. Other cerebrovascular abnormalities, such as vascular malformations, cavernous angiomas, or intracranial aneurysms can also lead to brain hemorrhage. Additionally, brain tumors that rupture can cause hemorrhage, as can conditions where there are issues with blood coagulation function and poor clotting times. Some patients may experience brain hemorrhage due to cerebral lipoid degeneration, and trauma can also cause brain hemorrhage.

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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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What should be done about cerebral hemorrhage?

Cerebral hemorrhage is a relatively serious disease. After a cerebral hemorrhage occurs, patients usually experience noticeable headaches, nausea, and vomiting. The onset is relatively rapid, and it may present clinical symptoms such as slurred speech, deviation of the mouth, and paralysis of one side of the body. In severe cases, the patient may become comatose or even die. Once diagnosed with cerebral hemorrhage, it is necessary to immediately rush to the nearest hospital for treatment. It is important to ensure the patient rests in bed, keeps their emotions stable, avoids emotional excitement, and maintains regular bowel movements without straining. If cerebral hemorrhage causes increased intracranial pressure, dehydration medications to reduce intracranial pressure can be used. Additionally, medications to protect brain cells should be used. It is crucial to actively control the patient's blood pressure and, when the condition stabilizes, to perform regular rehabilitative exercises to promote the recovery of neurological functions. If the volume of the cerebral hemorrhage is large and threatens the patient's life, neurosurgery may be needed to save the patient's life.