Cerebral haemorrhage distinguishes between various forms: subarachnoid haemorrhage, epidural hematoma, subdural hematoma and intracerebral hematoma. In the following, the most important types of cerebral hemorrhage are briefly described.
As the name of this type of cerebral hemorrhage indicates, it is called a hemorrhage under the soft meninges, the arachnoid. In most cases, subarachnoid hemorrhage is due to the sudden rupture of an aneurysm of the cerebral arteries. Aneurysms represent sloughs of the vessel walls of varying localization, which either cause no discomfort at all, or can be the cause of years of seizure-like headache, often associated with additional neurological deficits. If an aneurysm ruptures at the basilar cerebral arteries, subarachnoid hemorrhage (SAB) of varying severity results. Less common causes of SAB are brain tumors, leukemias or coagulation disorders.
SAB can occur after years of previous headache or vision loss headaches described above. Often, however, she suddenly starts out full of health without a harbinger. It occurs not only after physical exertion with elevation of blood pressure, but more often spontaneously, often even out of complete rest. The level of arterial blood pressure plays no role in the occurrence of subarachnoid hemorrhage. The first symptom is a sudden, unexperienced headache that spreads rapidly from the neck or forehead to the whole head and within hours to the back.
Often it also comes to vegetative symptoms: vomiting, sweating, increase or decrease in blood pressure, fluctuations in body temperature and changes in the frequency of pulse rate and respiration. Some patients immediately fall unconscious to the ground in acute subarachnoid hemorrhage. In other cases, initially there are only slight disturbances of consciousness, which may increase in the further course. All in all, the spectrum of possible manifestations ranges from pure headaches, to clouding of consciousness with neurological deficits and neck stiffness, to deep coma and brain death. Also, epileptic seizures may occur as an expression of irritation of certain brain centers.
The suspected diagnosis SAB can often be made solely on the basis of the typical symptom picture, but usually requires confirmation by computer tomography of the skull. Also, electroencephalogram (EEG) and electrocardiogram (ECG) may have nonspecific changes. Overall, after first-time SAB, 25 percent of patients die within the first week. Any recurrent bleeding for which the risk is highest within the first two to three weeks after first bleeding reduces survival prospects by 30 percent. Without surgery, mortality due to subarachnoid hemorrhage is approximately 70 percent in 5 years.
An epidural hematoma is a hemorrhage between the skull bone and the outer surface of the dura mater, which usually occurs as a result of cranial trauma. The epidural hemorrhage is usually based on an arterial tear. This often arises, but by no means always, through a fracture of the temporal and parietal skulls. The hematoma usually occurs on the equilateral side of the fracture.
The triggering trauma can be minor and does not even lead to a concussion. Severe trauma can lead to the acute onset of a neurological half-sided symptom with serious disturbances of consciousness. On the other hand, if the trauma was mild, a symptom-poor, so-called free interval of a few minutes to hours follows the initial symptoms. Thereafter, the condition of the sick increasingly deteriorates again. Consciousness becomes cloudy and half-sided paralysis forms on the opposite side due to compression of one half of the brain. On the side of the hemorrhage the pupil becomes far and light-stared by paralysis of an important, eye-supplying nerve.
Compared to subarachnoid hemorrhage, computed tomography of the skull is the diagnostic method of choice. In individual cases, vascular imaging of the cerebral vessels with X-ray contrast agent is also required. Failure to diagnose in time will result in fatal compression and paralysis of vital brain centers. With timely surgical intervention, complete healing can be achieved. Often, however, neurological damage also remains.
In contrast to the epidural hematoma, a subdural hematoma corresponds to a collection of blood below the dura mater and often results as an accident due to the rupture of venous blood vessels. The subdural hematomas are usually less sharply delimited against the brain than the epidural hematomas and show a mostly more extensive spread. The clinical symptom constellation and the course of the acute subdural hematoma are comparable to the epidural hematoma. Again, the suppression and compression of brain structures with subsequent loss of consciousness and neurological deficits in the foreground.
The chronic variant of the subdural hematoma is often associated with less dramatic symptoms such as slowly progressive changes in consciousness or drive disorders, which can complicate the diagnosis in part. In any case, the correct diagnosis can be made with high reliability in the context of a computed tomography of the skull, the prognosis of the disease essentially being dependent on timely surgical intervention.
The intracerebral hematoma inside the brain occurs either as a result of craniocerebral trauma or after bleeding from a small cerebral vein that has been pre-damaged for many years by hypertension. Depending on the location of the bleeding, different brain centers with different symptom severity may be affected. Relatively typical is the acute occurring hemiplegia on the opposite side of the body. Hypertensive intracerebral hematomas account for approximately 20 percent of non-traumatic strokes.
The confirmation of diagnosis is again best done by computed tomography, wherein in acute stroke, the differentiation between a deficient circulation and a hemorrhage of significant therapeutic importance.