Diagnosis
Imaging techniques are required to diagnose ICB. In the computer tomogram (CT), the location and size of the bleeding, as well as the increase in size (possible up to 30%) can be checked by a new CT after 24 h. MRI of the head (head MRI) and MRI of the brain can also detect bleeding, but they are second-choice methods due to price, availability and the usually significantly limited general condition of the patient. Due to characteristic signal changes in the MRI of the head, older bleedings can also be detected, and special procedures can be used to visualize vessels to detect possible malformations or dilatations (MRI angiography).
Normally, no additional laboratory diagnostic examinations, such as an examination of the parameters of the cerebrospinal fluid (CSF), are indicated. In the acute diagnosis of a cerebral hemorrhage, the diagnostic tool of first choice is the CT, as it can be performed very quickly and easily. This is the most effective way to obtain information in an emergency situation.
However, the MRT is also an important diagnostic tool. Especially in the case of uncertain findings in the CT, a rather slowly developing symptomatology or an uncertain symptomatology, the MRI can provide extended findings. In some cases, these are better suited to exclude other possible diagnoses. Particularly if chronic bleeding is suspected, MRI is usually superior to CT. Furthermore, the MRI is also used in the course of the disease to narrow down and depict causes such as vascular changes, tumors and others.
Surgery for a cerebral hemorrhage
A cerebral hemorrhage is treated in different ways, depending on the location and extent of the bleeding. In addition to the possibility of influencing the course of the bleeding by administering certain drugs, neurosurgical surgery may be necessary. Diagnostic imaging is essential prior to surgery, as the location of the bleeding must be determined before surgery.
Computer tomography can quickly provide a detailed image of the injury and is therefore usually used in cases of cerebral hemorrhage. Surgical removal of the effusion of blood in the brain always involves opening the skull. In case of superficial bleeding, it may be sufficient to open the skull at the site of the blood accumulation.
In some cases, the source of bleeding must be found and stopped and the blood must be removed using minimally invasive procedures. If necessary, this can be done using a robot or “by hand”. Which methods are used in individual cases depends on the type of bleeding, the skills of the surgeon and the equipment of the hospital.
If surgery is necessary for a cerebral hemorrhage, it is usually performed within the first 72 hours after the occurrence of the bleeding and can improve the prognosis of the affected person. Click here for the main page on this topic: Surgery for cerebral hemorrhageSurgery for cerebral hemorrhage is not uncommon, but not every cerebral hemorrhage per se needs surgery. There are criteria for deciding whether or not to operate on a cerebral hemorrhage.
So-called epidural haemorrhages must always be operated on, as immediate relief of the brain must be guaranteed. Otherwise there is a risk of bruising and irreversible damage. In the case of aneurysm bleeding (subarachnoid hemorrhage), the decision on surgical therapy of the aneurysm is made individually.
It is also possible to treat the aneurysm with a catheter (interventional).Subdural hematomas are treated surgically if there are symptomatic signs of increased intracranial pressure or if there are constrictions of the brain. A deterioration in the state of consciousness and orientation of the affected person also speaks for surgery. Intracerebral haemorrhages are always decided on a case-by-case basis.
Whether or not an operation should be performed is always considered on an individual basis. Cerebellar hemorrhages are usually more likely to be operated on. Extensive bleeding into the ventricles of the brain is also a reason for surgery.
Surgical therapy is not recommended for every cerebral hemorrhage. In this case, conservative therapies are performed, which have different goals and vary depending on the type of cerebral hemorrhage. Severe intracerebral hemorrhages are treated in an intensive care unit.
In most cases, the affected patients are ventilated and sedated. They receive pain therapy and are monitored. In addition, the blood pressure is adjusted to a systolic value below 140 mmHg.
An important goal is the monitoring of coagulation. Anticoagulant medication is discontinued to prevent further bleeding. If necessary, coagulation factors are administered or drugs that cancel the effect of anticoagulants are taken.
Another important goal is to reduce the pressure in the brain. Various therapeutic options are used to achieve this. Brain water or blood can be drained via a small tube in the ventricle system.
This is called external ventricular drainage. Furthermore, drugs can be administered to lower the cerebral pressure. The duration of an operation for a cerebral haemorrhage cannot be given as a general rule.
There are several reasons for this. Cerebral haemorrhages are not all treated by one and the same operation, firstly because they can be of different nature and secondly because they differ in their extent and localization. In most cases, however, it can be assumed that the operation will take several hours, as it is a rather complex operation.
