Cerebral hemorrhage: what are the symptoms and how is it treated

Cerebral hemorrhage is the appearance of a quantity of blood within the brain parenchyma and which will give rise, in most cases, to a neurological deficit of some consideration.

Risk factors for cerebral hemorrhage

The most important risk factors for general hemorrhage are age, sex (more in males), race (more in blacks than in whites), alcohol and drug use, and liver dysfunction.

Causes of cerebral hemorrhage

The main causes of cerebral hemorrhage are:

  • Arterial hypertension, either acute or chronic.
  • Processes that increase cerebral blood flow.
  • Vascular anomalies, such as arteriovenous malformations or aneurysms.
  • Arteriopathies, being amyloid angiopathy the most frequent.
  • Brain tumors
  • Coagulopathies
  • Brain infections

Symptoms of cerebral hemorrhage

Cerebral hemorrhage usually has a mild onset that progresses in minutes or hours. This fact differentiates it from cerebral infarction (ischemic or embolic), whose onset is sudden.

The symptoms are usually headaches, vomiting and alterations in the level of consciousness. If this last symptom progresses, it can lead to coma and finally to the patient’s death.

The most common clinical signs are hemiplegia, hemihypoesthesia or hemianopsia in varying degrees of involvement, which can lead to irreversibility of the damage caused.

Diagnosis of cerebral hemorrhage

The best and quickest diagnostic test for specialists to detect cerebral hemorrhage is computed axial tomography. The CT scan not only shows the presence of blood in the brain parenchyma, but also pinpoints its location and detects whether it is causing a mass effect or expansion within the brain, which is even more harmful than the initial hemorrhage.

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Magnetic resonance imaging is another tool to be used in case there is suspicion of the existence of an underlying pathology, such as a vascular malformation or a tumor.

Treatment of cerebral hemorrhage

In most cases the treatment will be conservative, trying to control blood pressure. If it is high, it should be reduced to the levels it had before the onset of the clinical picture, more or less, but never below these, because this could lead to cerebral ischemic problems, which would considerably aggravate the process.

Other measures to be applied are: correcting blood coagulation problems and maintaining a patent airway for good cerebral oxygenation.

Surgical treatment is very controversial in supratentorial hemorrhages and there have been several randomized multicenter studies that have failed to demonstrate a benefit of surgery over conservative treatment.

However, when the hemorrhage is intracerebellar the surgical option should be strongly considered.