Introduction
A cerebral hemorrhage (intracranial hemorrhage) is a bleeding within the skull. A distinction is made between intracerebral hemorrhage (bleeding into the brain tissue) and subarachnoid hemorrhage (bleeding between the middle and inner layers of the brain). In both cases, the bleeding causes compression of surrounding brain areas, a reduced supply of blood to the brain tissue supplied by the affected vessel and an increase in pressure within the skull.
Depending on the location of the hemorrhage, characteristic symptoms occur as a result. However, these are usually not specific to a cerebral hemorrhage and cannot be distinguished from the symptoms of a cerebral infarction. Imaging is therefore necessary for further differentiation.
What are the typical signs of a cerebral hemorrhage – bullet points?
A cerebral haemorrhage can cause numerous symptoms. However, it is important to remember that not all symptoms need to occur in a patient in order to diagnose a cerebral hemorrhage. Typically, the symptoms listed below occur suddenly and increase as the bleeding progresses.
Common symptoms of a cerebral hemorrhage are: sudden onset of very severe headache (destruction headache), nausea and vomiting, dizziness (difficulty walking, balance problems), sudden weakness (paresis) or paralysis (plegie) of the muscles, usually restricted to one side of the body (hemiparesis or hemiplegia), especially Feelings of numbness in the area of the face, arms and legs (also frequently arms, legs or face affected) Speech disorders (aphasia) and speech disorders (dysarthria) Visual disorders (seeing double images, blurred vision, loss of one side of the visual field, deviating direction of gaze) Further possible symptoms: Swallowing disorders, clouding of consciousness (up to unconsciousness or coma), seizure (epileptic seizure)
- Sudden onset of very severe headache (destruction headache)
- Nausea and vomiting, dizziness (difficulty walking, balance problems)
- Sudden weakness (paresis) or paralysis (plegie) of the muscles, usually limited to one side of the body (hemiparesis or hemiplegia), especially in the area of the face, arms and legs
- Numbness (also often arms, legs or face affected)
- Speech disorders (aphasia) and speech disorders (dysarthria)
- Visual disturbances (seeing double images, blurred vision, half-sided visual field loss, deviating direction of vision)
- Other possible symptoms: difficulty swallowing, clouding of consciousness (up to unconsciousness or coma), seizure (epileptic seizure)
The most common symptom of a cerebral hemorrhage is headache. Typically, headaches occur suddenly when there is bleeding in the brain. The pain is often preceded by physical exertion.
Compared to classical headaches, the pain is much stronger and is spread over the entire head, which is why it is also called ‘destruction headache’. Bleeding into the brain tissue causes an increase in pressure within the skull. This irritates the meninges surrounding the brain, which contain numerous sensitive nerves.
As a result, a further increase in pressure (e.g. due to further bleeding in or after the brain tissue) within the skull leads to an increase in the patient’s headache. In addition to the headaches, patients often report dizziness. The bleeding into the brain tissue and the resulting increased intracranial pressure compresses or disturbs nerve nuclei in the brain stem and cerebellum.
The central regulation of the sense of balance takes place in these nerve nuclei. As a result, the patient may experience a partially diffuse dizziness. Clinically, there is an insecurity of gait as well as numerous balance and coordination problems, which can be checked by means of numerous tests.
A further sign of a cerebral hemorrhage can be unevenly sized pupils and a lack of pupillary response to light irradiation. The increased pressure caused by a cerebral hemorrhage can compress or damage the cranial nerves running within the skull. This can also affect the optic nerve (optic nerve, cranial nerve II) and the nerves that innervate the muscles of the eyes (oculomotorius nerve, cranial nerve III; trochlear nerve, cranial nerve IV; abducens nerve, cranial nerve VI).As a consequence, a lack of pupil reaction to light or pupils of unequal size at rest may occur.
Nosebleeds, when isolated, are usually not a sign of a cerebral hemorrhage. Nevertheless, frequent and unstoppable nosebleeds can be a sign of a blood coagulation disorder with an increased bleeding tendency. This increased bleeding propensity can in turn be a cause of cerebral hemorrhage.
For this reason, further specialist medical clarification is recommended in cases of severe and frequent nosebleeds. In addition, heavy nosebleeds can also occur in the event of severe falls and injuries in the area of the skull. Together with the other symptoms mentioned, this can be a sign of a craniocerebral trauma with bleeding into the brain tissue.
Another common symptom of a cerebral hemorrhage is a blurred speech of the patient (aphasia). Depending on the area of the brain affected, both speech comprehension (Wernicke’s aphasia) and speech production (Broca’s aphasia) can be affected. In rare cases, speech comprehension and production are disturbed (global aphasia).
When speech comprehension is disturbed, spontaneous speech is usually fluid but without any context. Begun sentences are often interrupted or repeated. In case of a speech formation disorder, spontaneous speech is slowed down and faltering.
Only short sentences are formed under great effort. In addition, the patient’s speech may also be disturbed by irritation of the cranial nerves supplying the mouth and jaw muscles. Increased intracranial pressure can compress these nerves within the skull, which means that the muscles required for speech formation cannot contract or can only contract to a limited extent.
A cerebral haemorrhage often leads to sudden tiredness and even clouding of consciousness. However, this should not be confused with a pre-existing chronic fatigue or exhaustion. Typically, within a few seconds the patient appears altered and exhausted. Depending on the size and extent of the bleeding in the brain, the consciousness can become so clouded that the patient is in a coma.
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