What is a cerebral hemorrhage?
A cerebral hemorrhage is a rupture of a blood vessel (usually an artery) that causes bleeding in and around the brain. Cerebral hemorrhages are differentiated according to their location and according to the severity of the damage; we differentiate between:
- Spontaneous cerebral hemorrhage, related to arterial hypertension, coagulation problems, plateletopenia, tumors or formation of new blood vessels after ischemia, vasculitis, drugs or infections of the central nervous system, among others. It may be an intraparenchymal or intracerebral hemorrhage; it usually affects older people. This type of cerebral hemorrhage accounts for 10-15% of all strokes.
- Intraventricular hemorrhage, when it affects the ventricles of the brain containing cerebrospinal fluid. It affects premature infants, especially those who have had respiratory distress syndrome, pulmonary collapse or high blood pressure. In 70% of the cases this hemorrhage is secondary, that is, it derives from an intraparenchymal hemorrhage.
- Subarachnoid hemorrhage affects young people between 20 and 40 years of age and occurs in the subarachnoid space, outside the pia mater. It is a serious pathology that is usually caused by rupture of an aneurysm (the risk of rupture is proportional to its size), cranial trauma, use of anticoagulants, bleeding disorder, etc. It is common in older people who have suffered falls or been hit in the head and in young people who have been involved in a car accident.
- Subdural hematoma; located between the arachnoid and the dura mater, it is the most common traumatic bleeding. Sufferers often fall into a coma during hospitalization.
- Epidural hematoma; located between the dura mater and the skull, it may appear due to brain trauma. In most cases this type is the consequence of skull fracture in children and adolescents.
It is an intracranial hemorrhage (the other type is extra-axial; in which we find epidural hematoma, subdural hematoma and subarachnoid hemorrhage).
Bleeding caused by the rupture of a blood vessel in the brain is known as stroke.
Prognosis of the disease
A cerebral hemorrhage is a serious pathology that implies a risk of mortality. The main complications appear when the hematoma expands, due to perihematoma edema, intraventricular extension of the hemorrhage with hydrocephalus, seizures, venous thromboembolic episodes, hyperglycemia, arterial hypertension, fever and infections.
In general, the severity of each case will depend on the amount of blood spilled.
The mortality rate of cerebral hemorrhage is 40%.
On the other hand, the patient may be left with sequelae, such as loss of the ability to communicate, swallowing and vision problems, pneumonia, loss of sensation and depression, among others.
Symptoms of cerebral hemorrhage
The main symptoms of cerebral hemorrhage according to type are:
- Spontaneous cerebral hemorrhage: manifested by headache, vomiting, papilledema, bradycardia and decreased consciousness, among others.
- Intraventricular hemorrhage: apnea and bradycardia, high-pitched crying, convulsions, pale coloration or cyanosis, anemia, swelling or bulging of the fontanelles (soft spots between the bones of the infant’s head). Subarachnoid hemorrhage: vision problems, muscle aches, sudden severe headache, loss of consciousness, and nausea and vomiting, among others.
- Subdural hematoma; headache, difficulty with balance or walking, slurred speech, lack of energy, convulsions, nausea and vomiting, visual problems, etc.
- Epidural hematoma; the main symptoms are dizziness, confusion, nausea or vomiting, drowsiness, head trauma and weakness, among others.
A cerebral hemorrhage is a serious pathology that involves risk of mortality.
Medical tests for cerebral hemorrhage
The first step in detecting a stroke is to determine what type of stroke it is, and this can be known through a CT or MRI scan. In addition, to help determine the type, cause and location, as well as rule out other pathologies, blood tests, electrocardiogram, carotid ultrasound and cerebral angiography can be performed.
What are the causes of cerebral hemorrhage?
A cerebral hemorrhage may occur by accident or may be caused by traumatic brain injury.
Some risk factors for cerebral hemorrhage are hypertension, menopause, diabetes, smoking, alcohol and caffeine.
- Spontaneous cerebral hemorrhage: as mentioned above, it is usually related to high blood pressure. Some controllable risk factors are alcohol and smoking; another factor is diabetes mellitus.
- Intraventricular hemorrhage: the causes of this type of hemorrhage are not clear, although it may be due to very fragile and immature blood vessels in the infant’s brain. Those with respiratory problems (such as hyaline membrane disease) are more prone to hemorrhage. Hemorrhage almost always occurs in the first 4 days of life.
- Subarachnoid hemorrhage:
- Subdural hematoma; it is often the result of severe head trauma, but can also be the result of minor head trauma. On the other hand, they may appear for no reason. Some risk factors are: anticoagulant medications, medical conditions, prolonged alcohol consumption, etc.
- Epidural hematoma; often caused by a skull fracture during childhood or adolescence. It is more common in young people. It can also be caused by a ruptured blood vessel.
Can it be prevented?
Brain hemorrhages can be prevented by acquiring healthy habits (regular physical exercise, smoking cessation, weight loss) that help control cholesterol levels, blood pressure, sugar control, stress, mood, etc.
Treatments for cerebral hemorrhage
It is vital that a brain hemorrhage be treated immediately, so that life can be saved and the risk of disability reduced. The technique to be used will depend on the type and location of the stroke, but will generally focus on restoring blood flow and reducing pressure in the brain.
If a stroke is caused by a clot, it can be treated with drugs (which should be given within hours of the onset of the stroke). Other techniques would be surgery and intracranial vascular treatments.
Which specialist treats it?
Cerebral hemorrhages are treated by neurosurgeons.