Intracerebral hemorrhage (ICB or IZB) represents bleeding within the brain tissue. It is a hemorrhagic stroke that manifests with symptoms similar to those of an ischemic stroke. The prognosis of this hemorrhage depends on its location in the brain, its severity, and the start and course of medical treatment.
What is intracerebral hemorrhage?
About 15 percent of all strokes are caused by bleeding into brain tissue (hemorrhagic stroke). The remaining 85 percent are the result of decreased blood flow to specific areas of the brain. In both cases, there is death of brain tissue. The symptoms and course of hemorrhagic stroke depend on the region of their occurrence in the brain and on the severity of the bleeding. Furthermore, the correct therapy and the time of the beginning of emergency measures are also decisive for the chances of recovery. Most often, cerebral hemorrhage occurs due to the bursting of small arterial blood vessels. However, intracerebral hemorrhage can also be caused by injury to venous blood vessels. The causes are manifold. Diseases of blood vessels, coagulation disorders, use of anticoagulants, vascular malformations and many other factors play a role. Approximately one million hemorrhagic strokes are observed worldwide. Of these, approximately 90,000 people are affected in the European Union. However, there are strong regional differences that may be explained by particular environmental conditions, lifestyles, or genetic predispositions.
Causes
The most important cause of intracerebral hemorrhage is arterial hypertension. This risk factor could be found in 70 to 80 percent of all individuals with hemorrhagic stroke. Furthermore, the risk is also increased when taking anticoagulant medication. For example, preventive treatment of leg vein thrombosis, myocardial infarction, or ischemic sleep attacks with anticoagulants carries as much as an 11-fold risk of cerebral hemorrhage. Furthermore, the administration of acetylsalicylic acid after myocardial infarction or ischemic stroke leads to an increased risk of cerebral hemorrhage. This becomes particularly clear when several anticoagulant preparations are combined. The same applies to people with blood clotting disorders. Diseases of the blood vessels may also play a role in the etiology of intracerebral hemorrhage. Arterial diseases include acquired and genetic alterations of the small arterial blood vessels, amyloid angiopathy, cerebral aneurysm, vasculitis, moyamoya, and other diseases of the large arteries. Furthermore, vascular malformations can be the trigger of cerebral hemorrhage. Brain hemorrhages are also possible due to brain metastases. Sometimes the cause is not recognizable. In these cases, it is an idiopathic or cryptic intracerebral hemorrhage. Overall, drinking alcohol and smoking have been found to increase the risk of cerebral hemorrhage.
Symptoms, complaints, and signs
The symptoms of intracerebral hemorrhage (hemorrhagic stroke) are similar to those of ischemic stroke. In both cases, death of certain brain regions occurs. However, the symptoms and the course of the stroke depend on the affected brain region and the severity of the dead area. In varying degrees, headaches, nausea, vomiting, hemiplegia of the legs, arms or face, numbness, speech, vision or swallowing disorders, as well as dizziness, impaired consciousness and even epileptic seizures occur. It has been noted that the risk for an epileptic seizure is much greater with a hemorrhagic stroke than with an ischemic stroke. An epileptic seizure is particularly common within 24 hours of cerebral hemorrhage. In one-third of patients with intracerebral hemorrhage, epilepsy-type potentials were detected on the EEG without the need for an epileptic seizure. Hemorrhagic stroke can also lead to psychological changes, such as sudden changes in sensation and behavior and states of confusion, even coma.
Diagnosis and course of the disease
Cerebral hemorrhage can be reliably detected by computed tomography of the skull and differentiated from hemorrhagic stroke by differential diagnosis.Alternatively, an MRI scan is also possible.
Complications
In most cases, this hemorrhage results in the death of certain regions in the brain. In this case, the further course of the disease strongly depends on the affected region and the duration of this hemorrhage. Patients often suffer from very severe headaches, vomiting and nausea. Similarly, paralysis occurs in various regions of the body, so that the affected person may not be able to move his arms and legs. This not infrequently leads to severe restrictions in movement and further to considerable limitations in the patient’s everyday life. As the hemorrhage progresses, the patient may also experience an epileptic seizure. The quality of life of the affected person is then significantly reduced and restricted. Not infrequently, the damage to the brain also has a negative effect on the actions and thinking of the affected person, so that confusion or even a coma can result. Likewise, relatives may also suffer psychologically from the situation. The treatment of this hemorrhage is carried out by an emergency physician. In the process, possible consequential damage can be limited. However, the life expectancy of the patient is reduced in most cases.
When should you go to the doctor?
People who repeatedly suffer from headaches, nausea, vomiting, and dizziness should consult a physician. If the complaints increase in intensity, medical help is needed. If disturbances of attention, concentration or memory occur, this is a cause for concern and must be medically clarified. If there are problems with speech, interruptions in the ability to communicate, difficulty swallowing, and various dysfunctions, a doctor is needed. Interruptions in vision, hearing or other sensory modalities should be investigated and treated. If there are sensory disturbances, numbness or paralysis, a doctor’s visit is advised as soon as possible. If clouding of consciousness or loss of consciousness occurs, an emergency physician should be called. If epileptic seizures occur, disorientation sets in or breathing stops, an ambulance should be alerted. First aid measures must be taken until the ambulance arrives. There is a life-threatening condition that requires intensive medical care. In the case of behavioral abnormalities or changes in personality, brain changes are present that must be treated and diagnosed immediately by a physician. Sudden and unexpected abnormalities are considered a special warning sign in intracerebral hemorrhage. Immediate action and seeking medical attention is necessary to ensure the survival of the affected individual. In many cases, the affected person is unable to move his or her limbs and is barely responsive to questions asked.
Treatment and therapy
ICB is an emergency that must be treated as soon as possible. The patient is admitted to a neurologic or neurosurgical intensive care unit for treatment. The first measure is usually to lower the arterial blood pressure to stop the bleeding. However, lowering blood pressure is quite controversial because it could cause decreased blood flow in the region leading to intracerebral hemorrhage. However, in the majority of cases, blood pressure lowering has been shown to be beneficial. Furthermore, if the body temperature is elevated, it should be lowered. Excessive body temperature has an unfavorable effect on the course of the disease. In some cases, neurosurgical treatment is also performed. This depends on the cause of the hemorrhage, its location and course. If the hemorrhage occurs in the cerebral region, surgical treatment is performed only in exceptional cases. This consists, among other things, of hematoma evacuation in the case of serious deterioration of consciousness. If the hemorrhage is localized infratentorially in the cerebellar area, relief surgery often helps if the disease state worsens. If epilepsy-type potentials are detected on EEG examination, therapy with anticonvulsants should be given to prevent epileptic seizures.
Outlook and prognosis
The prognosis of intracerebral hemorrhage depends on the location of the irregularities. In addition, the severity of the hemorrhage and the course of the disease are decisive.In severe cases and without medical care, the affected person faces premature death. Due to a stroke or a heart attack, death occurs for many. Normally, intensive medical treatment is necessary to ensure the patient’s survival. The sooner medical care is given, the greater the chances of survival. In addition, permanent impairments and disorders are reduced. In many cases, long-term health irregularities occur despite prompt and professional therapy. Familiar daily activities can no longer be performed as usual and without assistance. General dysfunctions as well as losses in physical and mental performance occur. They lead to a reduced quality of life and can trigger secondary diseases. In particular, the psychological stress of the patient as well as the relatives increases and can trigger further illnesses. Numerous therapies are necessary to achieve a gradual improvement of the general health condition. Freedom from symptoms is not documented. The younger a patient is, the faster intensive medical treatment takes place and the fewer complications occur, the better the prognosis. In addition, the patient’s general health status must be taken into account.
Prevention
The most important measure to prevent intracerebral hemorrhage is prevention of hypertension. This can be achieved by a healthy lifestyle with a balanced diet, plenty of exercise, and avoidance of alcohol and smoking. If blood pressure is already chronically elevated, medication should be used to lower blood pressure in addition to lifestyle changes.
Follow-up care
After acute treatment of intracerebral hemorrhage, follow-up care begins. This consistently continues the rehabilitation measures already initiated. Depending on the individual situation, patients may not only participate in physiotherapeutic and occupational therapy measures, but also receive logopedic and neuropsychological care. Prophylaxis against high blood pressure is particularly important to prevent recurrence of the disease. This includes a balanced lifestyle. Healthy eating, sufficient activity and abstaining from cigarettes and alcohol minimizes the risk. If blood pressure is chronically elevated, sufferers can also take medication to lower it. These are prescribed by the attending physician. For patients, the actual treatment is initially followed by a rest period to take it easy. During this time, they should not put too much strain on their bodies and should avoid sports. Psychological stress can also have a negative effect and should therefore be avoided. Regular medical examinations are obligatory for good control. In this way, any complications are noticed immediately and the doctor can intervene in time. Depending on the severity of the disease, psychological therapy can be useful. Within the framework of such treatment or also in a self-help group, those affected learn to adapt to their situation. They should not do without this professional and social support.
What you can do yourself
Intracerebral hemorrhage is a medical emergency that must be treated immediately. First responders must provide first aid and immediately take the affected person to the nearest hospital or call the ambulance service. After treatment at the hospital, the patient requires rest and recuperation. It is advisable not to do any sports for a few days and also to avoid mental stress. Accompanying regular control examinations by the physician are indicated. This can ensure that the disease does not lead to serious complications. If unusual symptoms occur, the responsible medical professional must be informed. Sometimes the affected person needs psychological treatment. Especially in the case of severe bleeding, which resulted in a panic attack, a conversation with a therapist is useful. Chronically ill patients should also seek professional support and, if necessary, attend a support group. For hematomas, conservative remedies such as good wound care, cooling and sparing are helpful. Homeopathy offers belladonna and arnica, two effective preparations that relieve swelling and reduce pain. The use of these remedies should first be discussed with the doctor.
