General
A cerebral haemorrhage is always a medical emergency which must be treated as soon as possible. The term cerebral hemorrhage is colloquially used to describe a series of different bleedings within the skull. For example, a basic distinction must be made between bleeding between the brain and the skull and bleeding within the brain.
Depending on the blood vessel affected, the blood collects at different points within the skull. A cerebral hemorrhage in the narrow sense of the word involves a blood vessel that runs inside the brain. If it ruptures, a hematoma develops inside the brain.
This is dangerous because there is only limited space available inside the skull and with a growing hematoma there is the danger of entrapment of important areas of the brain. The bleeding causes symptoms that can vary greatly depending on the extent and location of the bleeding. The specific symptoms of a cerebral hemorrhage are very similar to the symptoms of a cerebral infarction.
In both diseases, an impairment of the respective brain areas is the reason for the development of the symptoms. Common symptoms of a cerebral hemorrhage are headache, nausea and vomiting, visual disturbances, sensitivity disorders, swallowing disorders, paralysis on one side of the body, dizziness, and seizures. In the case of advanced entrapment of certain areas of the brain, unconsciousness and respiratory arrest may occur.
Common symptoms of a cerebral hemorrhage are headache, nausea and vomiting, visual disturbances, sensitivity disorders, swallowing disorders, paralysis on one side of the body, dizziness, as well as seizures. In the case of advanced entrapment of certain areas of the brain, unconsciousness and respiratory arrest may occur. A cerebral haemorrhage causes in most cases a very strong headache.
Most people describe the headache as “more severe than ever” and “devastating”. In the case of a very severe headache, which never occurred in this form before, a doctor should therefore be consulted to clarify a cerebral haemorrhage. A so-called “destructive” pain is typical for the rupture of a cerebral artery aneurysm.
The headache, which occurs in the context of a cerebral haemorrhage, can be explained by the increase in volume within the skull. The increase in volume and limited space within the skull creates pressure on the meninges, which are supplied with nerves. This pressure causes the headache, which is why it can be an indication of a cerebral hemorrhage.
Nausea is a very common and early symptom of cerebral hemorrhage. Together with vomiting and headaches, this can be an important indication of a cerebral hemorrhage. The nausea is caused by a special area in the brain stem.
This so-called “vomiting center” is very sensitive and reacts to an increase in pressure. Typically, nausea and vomiting occur during a cerebral hemorrhage because the bleeding causes the pressure in the skull to increase and activates the vomiting center. This symptom is also frequently found in brain tumors.
Various drugs can target the vomiting center in the brain and reduce the nausea caused by a cerebral hemorrhage. Vomiting and nausea usually go hand in hand. If the pressure in the brain increases considerably, as part of a cerebral haemorrhage, nausea can occur.
It is also a typical symptom of a strong cerebral hemorrhage. The vomiting does not subside until the pressure is reduced or certain drugs are administered. A cerebral hemorrhage usually results in a volume-related constriction of certain cranial nerves.
Depending on the affected nerve, different symptoms can occur. An important symptom that can indicate the presence of a cerebral hemorrhage is the so-called pupil difference. The size of the two pupils of the affected person is compared.
If there is a difference in the size of the pupils of both eyes, there is an indication that a cerebral hemorrhage is present. Even if one or both pupils cannot be made smaller for a light stimulus, the suspicion of a cerebral hemorrhage is raised. In both cases, there is an acute need for medical action, as this is a life-threatening situation.
If fever occurs, this is in most cases a reaction of the body to an infection. If a cerebral hemorrhage occurs, however, the simultaneous presence of an infection is rarely the cause of sudden fever. Fever, which can be associated with a cerebral hemorrhage, can occur due to a so-called SIRS (systemic inflammatory response syndrome).
This severe reaction of the body is caused, for example, by major operations or injuries.In addition to fever, this clinical picture also includes an increased heart rate, rapid breathing and changes in blood count. A hemiplegic weakness can be a threatening symptom of a cerebral hemorrhage and persist even after a long time. The weakness affects the muscles and is usually first noticed on the face, arms or legs.
In severe cases, the muscles can become completely paralyzed. The reason for this is the failure of the controlling structures in the brain. The exact nature of the weakness is strongly dependent on the size and exact location of the cerebral hemorrhage.
In the outer edge of the brain are the central controls of all movements that are triggered by muscles in the body. From there, the nerve tracts extend to the spinal cord and then as a nerve to the respective muscle. On their way, the nerve cords cross the sides, which is why the hemiplegic weakness often occurs on the opposite side of the body to the brain hemorrhage.
At first glance, a cerebral hemorrhage cannot be distinguished from a stroke with regard to the hemiparesis weakness. In both diseases, there is direct damage to nerve cells in the brain. The extent to which the nerve cells can regenerate and regain their function after a cerebral hemorrhage is over varies greatly from individual to individual.
A prognosis for the improvement of hemiplegia can therefore not be made with certainty. Paralysis represents the advanced form of hemiplegia. Here, too, in acute cases of cerebral hemorrhage, motor nerve cells in the cerebral cortex or nerve cords in their course to the muscle perish.
This means that electrical stimuli can no longer reach the nerves and muscles in the arms and legs. As in a stroke, the paralysis can be very suddenly noticeable, for example, by a drooping corner of the mouth. In the case of complete paralysis, the nerve cells can partially regain their function during the healing phase.
A complete recovery of the paralysis is questionable. A numbness can occur together with muscular weakness or paralysis. The cerebral hemorrhage damages nerves that transmit sensitive information from the body to the brain.
Complete numbness is the most extreme form of numbness. At first, tingling and pain may occur. Stroke is also an important differential diagnosis to cerebral hemorrhage in cases of numbness.
If a speech disorder is present, several causes can be underlying. Most forms of speech disorders can be triggered by a cerebral hemorrhage. It is therefore important to determine the exact nature of the disorder in order to narrow down the affected area of the brain and the damaged structures.
First of all, a motor speech disorder may be present, which is caused by damage to the nerve cells that serve to move muscles, similar to hemiplegia. Deficiencies of the mouth and larynx muscles can cause articulation and speech formation disorders. Hoarseness can also be caused by such motor paralysis.
However, a cerebral hemorrhage can also damage one of the speech centers in the brain, as in a stroke. The two most important areas of speech formation that can be affected are the Broca and Wernicke centers. If the former fails, speech formation disorders occur, which can manifest themselves as stuttering and articulation problems, for example.
In a so-called “Wernicke’s aphasia”, speech comprehension is damaged. The affected person cannot remember individual words or they are replaced by similar-sounding sounds, so that sometimes a well articulated but meaningless language is produced. The severity of the speech disorder is strongly dependent on the extent of the cerebral hemorrhage.
Even in the case of severe disorders, however, many abilities can often be regained through many years of practice. The swallowing process is a neurologically complex interaction of sensory and motor processes. In the brain, swallowing is controlled by several centers and implemented in individual phases by the pharyngeal muscles.
Both cerebral hemorrhage and stroke can cause swallowing disorders due to damage to individual structures involved. In the case of disorders in the upper part of the esophagus, there is a risk that food will enter the trachea, which can lead to pneumonia. Visual disturbances of many kinds are possible with cerebral haemorrhages, but they rarely occur overall.
A visual disturbance can range from double images and reduced color and sharpness perception to visual field loss and complete blindness.In the brain, the visual pathways that conduct the signal from the eyes to the cortex can be affected, or the visual center of the cortex itself. Tumors, strokes and severe head injuries can also cause such visual disorders. In most cases, nosebleeds can be considered harmless.
It is not particularly important in the sole diagnosis of a cerebral hemorrhage. In the case of a known cerebral hemorrhage, a nosebleed is very unlikely, but in very rare cases it can be a symptom of bleeding. The nasal cavity is located close to the front, lower edge of the brain and can therefore become symptomatic in various processes in the brain.
A cerebral hemorrhage can lead to an increase in intracranial pressure. As a result, small blood vessels can be injured and bleed into the nasal cavity. There, in the tip of the nose, there is a vascular network that is very susceptible to pressure and different forces and causes the nosebleed.
Dizziness is a very unspecific symptom, which can have numerous causes. In the case of a cerebral hemorrhage, dizziness can also occur. This is often caused by anemia or a lack of oxygen in the brain.
Dizziness can be the first symptom before fainting with unconsciousness. Cerebral hemorrhages can also damage the organ of balance. This is located in the inner ear and is intricately interconnected in the brain to maintain a permanent balance.
In case of failures of involved regions, dizziness may occur. Consciousness is a body function that is difficult to measure and is based on an interplay of dozens of bodily functions. In general, consciousness includes the function of the senses, attention and alertness, as well as well-being.
Medically, consciousness can be divided into stages. In most cases, coma is the lowest level of consciousness, which is called unconsciousness. Important stages of consciousness are the reactions to response, touch and pain.
During a cerebral hemorrhage, the increasing bleeding and subsequent swelling of the brain causes a strong increase in intracranial pressure. This is often reflected in the brain stem, which controls the body’s functions. Increased pressure on the brain stem quickly leads to a clouding of consciousness and subsequent unconsciousness.
Unconsciousness can also be induced by medication to spare the nerve cells for the healing process. A cerebral hemorrhage can be a typical trigger of an epileptic seizure. The bleeding can cause a kind of scar in the nerve tissue of the brain, which can also promote epileptic seizures afterwards.
As a result, electrical signals are amplified, which quickly leads to a strong overexcitability of the cells. Severe cerebral hemorrhages can be accompanied by a coma. Coma is the most severe form of complete unconsciousness.
With certain cerebral hemorrhages, a kind of artificial coma can also be induced to spare the body for a certain period of time so that damaged areas of the brain can recover. During cerebral haemorrhage, it is not uncommon for the brain to swell and the cerebral pressure to rise sharply. The patient can fall into a coma due to the increasing pressure on vital brain regions, for example the brain stem. A prognosis for patients with cerebral hemorrhage who are in a coma cannot be made. This is due to the fact that the brain is able to regenerate to varying degrees and therefore potential consequential damage cannot be predicted with certainty.
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