Therapy
The therapy of a cerebral haemorrhage associated with a coma is primarily based on artificial maintenance of vital functions. Intensive medical care of the affected person is necessary. Artificial respiration is also necessary, since the respiratory reflex of the affected person usually fails due to the coma.
In order to keep the brain damage as low as possible and to restore the consciousness of the affected person, a reduction of the cerebral pressure is aimed for. To achieve such a reduction, among other things, an artificial lowering of blood pressure is carried out. There are also drugs that can specifically lower the pressure inside the skull.
In individual cases, invasive measures can help to lower the intracranial pressure. These interventions can include a manual evacuation of the blood and the insertion of a small tube (drainage) into the brain. Therapeutic measures that do not directly treat cerebral hemorrhage, but which can prevent frequently occurring complications, should also be undertaken.
These include thrombosis prophylaxis as well as close observation of the blood values of those affected. A tracheotomy is a measure that is performed during long-term artificial respiration. There are different procedures, which are summarized under the term tracheotomy.
In the context of a cerebral hemorrhage, which is accompanied by a coma, a tracheotomy is usually necessary, since this is necessary for long-term ventilation. The doctor pierces the trachea of the anesthetized patient from the outside with a needle and inserts a wire. The hole in the skin and the trachea is then widened so that a plastic tube fits into it, through which the patient can be ventilated. During this procedure, the patient is sedated and does not notice the procedure.
Consequences
The consequences of a cerebral haemorrhage, which are associated with a coma, can be very different. In the best case, those affected do not suffer any consequences of the disease.In far more cases, however, a severe cerebral hemorrhage is accompanied by permanent brain dysfunction. These can affect any area of the brain.
Particularly common are paralyses as well as disorders of speech production, speech comprehension, seeing, hearing or problems with swallowing. A cerebral hemorrhage, which is accompanied by a coma, also often leads to death. This is either caused by excessive damage to the brain or due to complications.
Typical complications are diseases such as pneumonia or blood poisoning (sepsis). Pneumonia is a disease that is relatively common in people who suffer from cerebral hemorrhage. Especially patients who are artificially ventilated due to coma are at risk for pneumonia.
Thus it happens again and again that bacteria get into the lungs via the ventilation and lead to an inflammation there. This is a very serious complication that can lead to the death of the person affected. Depending on which pathogen is responsible for the pneumonia as well as the individual condition of the affected person as a whole, the prognosis of the disease is determined.
A cerebral hemorrhage accompanied by a coma is a very severe disease, which can often end in death. This can occur due to brain damage (brain death) or due to complications. Brain death describes a condition in which all brain functions have been irreversibly damaged.
The damage to the cells of the brain is accompanied by death. The diagnosis of brain death is very extensive. It must be determined independently by two physicians.
During the coma, complications can also occur, which can also end in death. Especially pneumonia as well as blood poisoning (sepsis) can cause this serious consequence. The individual prognosis of a cerebral hemorrhage with accompanying coma depends on various factors.
Overall, however, the prognosis of the disease can be classified as poor. Thus, the symptom of coma can be classified as a poor prognostic factor of a cerebral hemorrhage. However, the individual prognosis is influenced by other factors.
In particular, the cause of the bleeding and the age of the patient play an important role in the assessment of the prognosis in individual cases. The duration of a coma due to a cerebral hemorrhage is very difficult to estimate. This is significantly influenced by the extent and location of the bleeding.
Depending on how badly the cells in the brain have been damaged, the duration of the coma can vary. However, it is often not possible to predict how long the coma will last, even if the extent and localization of the bleeding are known. A wait-and-see attitude and intensive therapy can help to reduce the individual duration of the coma.
Not in all cases, however, one can expect to wake up from the coma. The nerves in the brain can be damaged by the bleeding and its consequences to such an extent that awakening is no longer to be expected. In case of a total loss of all activity in the brain, often only brain death can be diagnosed.
The therapy goal in the case of a cerebral hemorrhage with accompanying coma is the healing of the bleeding in the brain without complications and thus the regaining of consciousness. However, the therapeutic goal is not always achieved. For example, patients who suffer from a cerebral hemorrhage and develop a coma in the course of the disease have a relatively poor prognosis.
Those affected wake up when the pressure within the brain and skull decreases and the functionality of the crucial brain areas has not been damaged too much. Special diagnostic methods can provide indications of how likely it is that a person affected will wake up from a coma. By discontinuing certain drugs, regaining consciousness can be provoked in these cases.
The chances of survival of a person who suffers a brain haemorrhage and develops a coma can vary greatly. This mainly depends on the extent to which the bleeding or the cranial pressure damages the cells of the brain. If the damage is severe and the pressure is high, the brain may lose all its function and thus lead to brain death.
There are some studies that investigate the chances of survival of a cerebral hemorrhage with accompanying coma. However, the results of the studies sometimes differ considerably. The mortality rate, i.e. the proportion of patients with a cerebral hemorrhage that will die during the course of the disease, regardless of whether or not a coma occurs, is estimated at about 25-50%.It can be assumed that a coma significantly worsens this rate.
One study concluded that 91% of patients who suffered a coma as a result of a cerebral haemorrhage died in the course of the disease. Another study estimated the rate at well over 80%. Overall, the chances of surviving a cerebral hemorrhage when accompanied by a coma are therefore relatively poor.
However, the individual chance of surviving the event can be influenced by various factors that were not included in the studies. The cause of bleeding, previous illnesses and the age of the person affected also have an influence on the chances of survival. More on this topic under: What are the chances of survival in the event of a cerebral hemorrhage
