Differentiation forms of the cerebral hemorrhage on the basis risk factors
Mass bleeding (hypertensive bleeding), which accounts for 40% of ICB, occurs mainly in brain sections where vessels with rather thin walls are located. High blood pressure can cause these wall sections to change over time, resulting in fat deposits and the formation of bulges or dilatations of the vessels (microaneurysms). If the blood pressure suddenly rises sharply, e.g. under stress, these vascular dilatations can burst and a cerebral hemorrhage occurs, mainly in the area of the truncal ganglia and the thalamus, which among other things play a major role in controlling movement and complex memory performance.
Likewise, bleeding can occur, especially in younger patients, due to congenital or acquired vascular malformations, e.g. malformations or benign new formation of blood vessels (angioma) in the brain. In addition, there are diseases in which abnormally altered protein deposits (amyloid) in medium-sized arteries can lead to vascular wall changes with increasing age. Certain malignant primary brain tumors as well as metastases of certain tumors can bleed into the brain tissue.
What are the typical signs of a cerebral hemorrhage
Most cerebral hemorrhages do not announce themselves in advance. They occur after serious accidents and injuries and can therefore show no signs. After an accident, a cerebral hemorrhage can never be ruled out reliably on the basis of the symptoms, which is why imaging should always be performed in the case of head injuries or whiplash injuries.
This is the only way to see bleeding safely. Signs are disturbances of consciousness, headaches or even paralysis. For the examiner, even unusual pupillary reflexes are a strong sign of a cerebral hemorrhage.
Subarachnoid hemorrhage is a special case, which in about 25% of cases is accompanied by a so-called warning leak. This precedes the actual bleeding for days or weeks and is accompanied by severe headaches. In most cases it is not taken seriously by those affected, so that no doctor’s visit is necessary.
ICB leads to an increase in volume and intracerebral pressure (intracranial pressure) in the brain. Initially, the blood volume and the volume of the cerebrospinal fluid (liquor cerebrospinalis) are reduced compensatorily. In the long term, this can lead to a decrease in blood flow to the brain and thus to a reduced supply of oxygen to the tissue (ischemia), which causes additional damage to the nerve tissue.
Typically, symptoms such as: as a sign of increased intracranial pressure occur very suddenly. Depending on the location of the bleeding, localized neurological deficits and/or disturbances of consciousness may also occur. In many cases, the neurological pattern of loss of consciousness gives an indication of the localization of the bleeding even without an imaging procedure.
The thalamus is partly responsible for the generation of muscle movements. If bleeding occurs in this area, paralysis typically occurs on the opposite side of the arms and legs or in the face. Bleeding in the area of the truncal ganglia also causes headaches and vomiting after the initial symptoms, typically hemiparesis on the opposite side and a turning of the gaze to the affected hemisphere of the brain.
Another typical symptom of hemorrhage in the area of the brainstem ganglia of the dominant hemisphere is speech, reading and language comprehension disorders (aphasia). Bleeding in the area of the cerebellum often leads to dizziness, gait insecurity and unnatural, rapid, directed eye movements (nystagmus). Hemorrhages of the brain stem are particularly dangerous, since this is where vital centers for respiratory and circulatory regulation are located.
There may also be multilocular, i.e. several bleeding foci distributed at different locations in the brain, with correspondingly diverse deficits. They frequently occur in diseases associated with abnormal protein deposits (amyloid angiopathy) or in coagulation disorders. If the bleeding breaks into the spaces (ventricles) filled with cerebrospinal fluid (cerebrospinal fluid), there is a risk of the development of a cerebrospinal fluid accumulation (hydrocephalus occlusus), which may lead to a life-threatening increase in cerebral pressure.
- Headaches
- Nausea and
- Vomiting
A cerebral hemorrhage can cause a number of different symptoms.
A coma is a state of consciousness that occurs relatively frequently in the course of a cerebral hemorrhage. In a coma, the affected person cannot be awakened even by a strong pain stimulus. In general, bleeding in the brain leads to an increase in pressure and volume in the skull.
Since there is only limited space available in the skull and this space does not adapt to the size of the haematoma, the pressure in the skull increases. The increase in pressure typically causes certain areas of the brain to be pinched off during the bleeding. This very often leads to a constriction of the brain stem.
The brain stem is responsible for a number of important functions of the body. A constriction of this structure usually results in a loss of consciousness and respiratory arrest. A coma is a very severe symptom that can occur during a cerebral hemorrhage. It is usually an acutely life-threatening condition, as coma is a sign of impairment of the cells of the brain.
