By definition, a cerebral hemorrhage is bleeding into the brain itself or its envelope structures that can lead to increased intracranial pressure and neurologic deficits, often with fatal outcomes. Learn more about the causes of a brain hemorrhage as well as typical symptoms and common treatment options here.
Cerebral hemorrhage: burst vessel in the brain.
The brain, as the central nervous entity of all functions and processes in the organism, has a very vulnerable, gelatinous consistency. The surrounding enveloping structures, the soft and hard meninges and the bony skull, perform an important protective function. Nevertheless, as with all organs through which blood vessels flow, there is also a risk of hemorrhage in the brain if a blood vessel bursts. High blood pressure (hypertension) is often responsible for this, often in combination with arteriosclerosis. This causes the walls of the blood vessels to lose elasticity over time, so the blood vessels can rupture during sudden spikes in blood pressure and cause a cerebral hemorrhage.
Causes of cerebral hemorrhage
First among the cause statistics for cerebral hemorrhage are accidents, followed by hemorrhage from vascular malformations, and finally vessel rupture from hardening of the arteries, often as a result of years of high blood pressure. Another cause of cerebral hemorrhage can be changes in the blood vessels due to benign or malignant tumors or brain metastases. Pathological dilatations (aneurysms) on the blood vessels or a disorder of blood clotting can also cause a cerebral hemorrhage. Other possible causes of cerebral hemorrhage may include:
- Infections
- Inflammation of the blood vessels in the brain
- Thrombosis of the cerebral veins
- Increased blood flow in the brain (for example, after heart surgery, during migraine attacks, or after physical exertion)
- External force such as accidents
- Alcohol or drug abuse
Among the risk factors of cerebral hemorrhage is, for example, smoking. Thus, smokers have a two- to threefold increased risk of cerebral hemorrhage. However, obesity and elevated cholesterol are also risk factors.
Arterial and venous hemorrhage
In the human circulatory system, blood is supplied to organs through arteries, and blood is drained through veins. Where a blood vessel bursts is critical to the consequences:
- In most cases, bleeding from the arterial high-pressure system leads to life-threatening blood loss within a short time.
- Bleeding from the venous system, on the other hand, as experience teaches in most superficial skin injuries, is usually of a rather harmless nature.
Due to the special anatomical conditions of the brain – its embedding in a rigid bony structure – special initial conditions are present in cerebral hemorrhages. Since the bony skull cannot expand, hemorrhage within the skull inevitably leads to an increase in pressure and thus to substance damage of the sensitive nervous tissue. If the hemorrhage thereby exceeds a certain extent, one must expect damage to the brain substance that is primarily still reversible, but after a critical time limit has been exceeded, irreversible damage with corresponding neurological deficits must also be expected.
Types of cerebral hemorrhage
Depending on the underlying cause, cerebral hemorrhages have quite typical localizations:
- Epidural hematomas represent hemorrhages between the bony skull and the hard meninges. They often occur as a result of craniocerebral trauma, for example, after accidents or exposure to violence.
- In contrast, subdural hematomas are located one floor lower, between the hard meninges. Acute subdural hemorrhages usually have similar causes to epidural hemorrhages. Chronic subdural hematomas can also be triggered by blood-clotting medications.
- Even closer to the brain substance are subarachnoid hemorrhages. They are usually caused by injury or a ruptured aneurysm.
- Finally, intracerebral hematomas correspond to hemorrhages inside the brain itself. They usually occur suddenly and independently of traumatic circumstances such as an accident.
Symptoms of cerebral hemorrhage
Depending on the type of brain hemorrhage, the symptoms also differ – so for a layman, a brain hemorrhage is not easy to recognize.An acute cerebral hemorrhage due to an intracerebral hematoma can, for example, resemble a stroke in terms of symptoms and be accompanied by sudden onset of neurological deficits and unilateral paralysis. Typical signs of cerebral hemorrhage are:
- Nausea and vomiting
- Headache
- Dizziness
- General malaise and weakness
- Seizures
- (often hemiplegic) paralysis and numbness
- Speech, movement and sensory disturbances.
- Visual disturbances
- Disturbances of consciousness
- Unconsciousness
Frequently, severe headache, nausea, and vomiting appear as an immediate response to the hemorrhage, while the onset of other neurologic deficit symptoms occurs after a relatively symptomless latency period of minutes or even hours.
Cerebral hemorrhage: rapid diagnosis is important
A quick diagnosis as well as immediate treatment are enormously important in the case of a brain hemorrhage, since otherwise consequential damage can occur or even life can be threatened. Because brain hemorrhages are not visible externally, they can initially be diagnosed solely on the basis of symptoms. First, the patient’s level of consciousness and the function of the nerves are examined. The development over time as well as accompanying circumstances of the symptoms are also of great importance for the diagnosis and subsequent treatment. In addition, imaging procedures such as computer tomography (CT) or magnetic resonance imaging (MRI), and sometimes X-rays, are used. Initial treatment usually resorts to CT because it provides a faster result than MRI. If the patient is stable, MRI examinations are the first choice. This is because, unlike CT, MRI can also image older bleeding, aneurysms or other malformations of the vessels. Both procedures provide information about the location and size of the brain hemorrhage. In addition, the imaging techniques can reveal any changes in size at a later time. In addition, both procedures make it possible to distinguish a brain hemorrhage from a brain clot (cerebral venous thrombosis), which causes similar symptoms.
Course and consequences of cerebral hemorrhage
The course of a cerebral hemorrhage is extremely dependent on the individual case. Factors that significantly determine the course of the patient’s disease include, in particular:
- The age
- The general state of health, such as existing underlying diseases.
- The location, size and type of cerebral hemorrhage
Extensive cerebral hemorrhage often leads to death. Permanent sequelae are seen in the vast majority of surviving patients. Possible sequelae of a brain hemorrhage are neurological deficits such as paralysis, speech or movement disorders. Mental disabilities are also possible. In addition, a stroke can occur as a complication as a result of bleeding into the brain. A cerebral hemorrhage is the trigger in about 15 percent of all strokes. Affected individuals can also fall into a coma as a result of a brain hemorrhage.
Treatment of a cerebral hemorrhage
Cerebral hemorrhage in any form is a medical emergency and therefore requires immediate treatment. The longer it takes to initiate initial treatment, the more the risk of a fatal outcome increases. Therefore, even if a cerebral hemorrhage is suspected, the emergency physician should be called immediately. In acute treatment, an attempt is first made to stabilize the patient. If the intracranial pressure increases due to the bleeding in the brain, surgery must be performed. The surgeon opens part of the skull bone to stop the bleeding in the head and remove the bruise. A CT scan is used for precise surgical planning. However, in extremely urgent emergencies, the skull must be pried open on suspicion. Even with rapid surgical intervention, however, there is a risk of fatal outcome or permanent neurological damage. Patients who have survived a cerebral hemorrhage require long-term rehabilitation treatment. Here, efforts are made to correct neurological and physical dysfunction. Depending on the severity of the cerebral hemorrhage, it can take several years before the patient is able to cope with everyday life again independently. In many cases, however, irreversible residual symptoms remain, such as problems with fine motor skills, concentration disorders, changes in character or headaches.If the cerebral hemorrhage was due to elevated blood pressure, the treating physician may prescribe antihypertensive medications to prevent further bleeding in the head.
Preventive measures
To prevent trauma-induced cerebral hemorrhage, refer to universally known accident prevention measures (for example, wearing a bicycle helmet when riding a bicycle). To reduce the risk of hypertension-related intracerebral hematomas, consistent drug treatment of hypertension is required. Also, all other risk factors such as diabetes, high cholesterol, and obesity should be brought under control. Furthermore, it is recommended not to smoke, to drink little alcohol, to exercise daily and to pay attention to a healthy diet. These measures not only help prevent cerebral hemorrhage, but also serve to promote a generally healthy lifestyle.
