Causes of cerebral hemorrhage

Written by Chen Yu Fei
Neurosurgery
Updated on September 10, 2024
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There are many causes of cerebral hemorrhage. In most cases, given that patients themselves already have certain underlying diseases, such as hypertension, diabetes, coronary heart disease, and arteriosclerosis, the blood pressure remains high over a long period. This causes the blood vessels to be in a constant state of tension. Over time, the vessels' ability to regulate and contract gradually weakens. When certain triggers occur, such as the patient experiencing fatigue, mental stress, or emotional excitement, the blood pressure temporarily spikes, exceeding the vessels' regulatory capacity, leading to the rupture of the blood vessels and causing cerebral hemorrhage.

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Written by Tang Li Li
Neurology
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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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How is cerebral hemorrhage treated?

For patients with cerebral hemorrhage, the first step is to urgently send the patient to the local hospital for medical attention and head CT scans. This primarily determines the current location of the hemorrhage, the severity of the bleeding, including the number of intracerebral hematomas. If there are multiple intracerebral hematomas causing significant mass effect and substantial compression on the surrounding brain tissue, leading to neurological damage, emergency surgical treatment is generally recommended. If the bleeding is minor with no significant mass effect, conservative treatment is advised. Treatment can include hemostasis, brain health promotion, nerve nutrition, acid suppression, and prevention of lung infections, among other approaches.

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Written by Chen Yu Fei
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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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Neurology
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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.

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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.