Cerebral hemorrhages: causes, diagnostics, course

By definition, cerebral hemorrhage is understood to mean hemorrhaging into the brain itself or its enveloping structures, which can lead to increased intracranial pressure and neurological deficits, often fatal. Find out more about the causes of cerebral hemorrhage as well as typical symptoms and common treatment options.

The brain as the central nerve of all functions and processes in the organism has a very vulnerable, gelatinous consistency. The surrounding enveloping structures, the soft and hard meninges and the bony skull, play an important protective role.

However, as with all organs that are traversed by blood vessels, there is also a risk of hemorrhage in the brain when a blood vessel bursts. Often, high blood pressure (hypertension) is responsible for this, often in combination with arteriosclerosis. As a result, the vessel walls gradually lose their elasticity over time, causing the blood vessels to rupture in the event of sudden blood pressure peaks and cause cerebral hemorrhage.

Causes of cerebral hemorrhage

First, the cause statistics for cerebral hemorrhages are accidents, followed by bleeding from vascular malformations, and finally, vascular ruptures in arteriosclerosis, often as a result of years of high blood pressure.

Another cause of cerebral hemorrhage may be changes in the blood vessels due to benign or malignant tumors or brain metastases. Even pathological enlargements (aneurysms) on the blood vessels or a disturbance of the blood coagulation can cause a brain hemorrhage.

Other possible causes of cerebral hemorrhage may be:

  • infections
  • Inflammation of the blood vessels in the brain
  • Thrombosis of the cerebral veins
  • an increased blood flow in the brain (for example, after a heart surgery, migraine attacks or after physical exertion)
  • external violence such as accidents
  • Alcohol or drug abuse

For example, one of the risk factors for cerebral hemorrhage is smoking. For example, there is a two to three-fold increase in the risk of cerebral hemorrhage among smokers. But overweight and elevated cholesterol levels are also risk factors.

Arterial and venous bleeding

In the human bloodstream, the blood supply to the organs via the arteries, the blood flow through veins. At which point a blood vessel bursts, is crucial for the consequences:

  • Bleeding from the arterial hypertension system will in most cases lead to life-threatening blood loss within a short time.
  • Bleeding from the venous system, on the other hand, is usually harmless, as experience with most superficial skin injuries teaches.

Due to the special anatomical requirements of the brain - the embedding in a rigid bony structure - there are special starting conditions for cerebral hemorrhage.

Since the bony skull can not expand, an influx within the skull inevitably leads to increased pressure and thus to the substance damage of the sensitive nerve tissue. If the bleeding exceeds a certain extent, primarily irreversible damage to the brain substance, which is still reversible after exceeding a critical time limit, must be expected with corresponding neurological deficits.

Types of cerebral hemorrhages

Depending on the underlying cause, the cerebral hemorrhages have very typical localizations:

  • Epidural hematomas are hemorrhages between the bony skull and hard meninges. They often occur as a result of craniocerebral trauma, such as after accidents or trauma.
  • In contrast, subdural hematomas are located one floor lower, between the hard meninges. Acute subdural haemorrhages usually have similar causes as epidural hemorrhages. Chronic subdural hematomas can also be triggered by blood coagulation drugs.
  • Closer to the cerebral substance are the subarachnoid hemorrhages. They are usually caused by injuries or a burst aneurysm.
  • After all, intracerebral hematomas correspond to hemorrhages inside the brain itself. They usually occur suddenly and independently of traumatic circumstances such as an accident.

Symptoms of cerebral hemorrhage

Depending on the type of cerebral hemorrhage, the symptoms are also different - for a layman, a cerebral hemorrhage is therefore not easy to recognize. An acute cerebral hemorrhage due to an intracerebral hematoma, for example, can be the same as a stroke and is accompanied by sudden onset of neurological deficits and unilateral paralysis.

Typical signs of cerebral hemorrhage are:

  • Nausea and vomiting
  • a headache
  • dizziness
  • general malaise and weakness
  • seizures
  • (often half-sided) paralysis and numbness
  • Speech, movement and sensory disorders
  • blurred vision
  • Disorders of consciousness
  • unconsciousness

Often, severe headache, nausea, and vomiting appear as an immediate response to hemorrhage, while onset of additional neurological deficit symptoms only occurs after a relatively low-burden latency of minutes or even hours.

Cerebral haemorrhage: A quick diagnosis is important

A quick diagnosis as well as an immediate treatment are enormously important for a cerebral hemorrhage, as otherwise consequential damage may arise or even mortal danger threatens.

Because cerebral hemorrhages are not visible externally, they can first be diagnosed solely on the basis of the symptoms. First, the patient's state of consciousness and function are examined. The temporal development as well as accompanying circumstances of the complaints are of great importance for the diagnosis and the subsequent treatment.

In addition, imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI), sometimes also X-rays, are used. Primary care is usually based on a CT, as it provides a faster result than an MRI. If the patient is stable, MRI scans are the first choice. In contrast to CT, an MRI can also image older bleeding, aneurysms or other malformations of the vessels.

Both methods provide information about the location and size of the cerebral hemorrhage. In addition, imaging processes can be used to visualize any size changes at a later date. In addition, both methods make it possible to distinguish a brain hemorrhage from a brain clot (cerebral vein thrombosis), which causes similar symptoms.

Course and consequences of cerebral hemorrhage

The course of a cerebral hemorrhage is extremely dependent on the individual case. Factors that determine the course of the disease significantly include:

  • age
  • the general state of health such as existing underlying diseases
  • the location, size and type of cerebral hemorrhage

Extensive cerebral hemorrhages often lead to death. In the vast majority of surviving patients, permanent sequelae can be observed.

Possible sequelae of cerebral hemorrhage are neurological deficits such as paralysis, speech or movement disorders. Even mental disabilities are possible.

In addition, it can come as a complication due to the hemorrhage into the brain to a stroke. Cerebral haemorrhage is the trigger in about 15 percent of all strokes. Also, sufferers can fall into a coma as a result of cerebral hemorrhage.

Treatment of cerebral hemorrhage

Cerebral hemorrhages are medical emergencies in every form and therefore require immediate treatment. The longer it takes to initiate primary care, the more the risk of fatality increases. Therefore, the emergency doctor should be called immediately in case of suspected cerebral hemorrhage.

In the acute treatment, an attempt is first made to stabilize the patient. If skull pressure increases due to hemorrhage in the brain, surgery is required. The surgeon opens part of the skull bone to stop the bleeding in the head and remove the bruise. For a precise operation planning a CT is used. In extremely urgent emergencies, however, the skull must be prone to suspicion. However, even with rapid surgical intervention there is a risk of fatal outcome or permanent neurological damage.

Patients who have survived cerebral hemorrhage require a lengthy rehabilitation treatment in long-term treatment. Here is an attempt to correct neurological and physical dysfunctions. Depending on the strength of the cerebral hemorrhage, it may take several years for the patient to master his everyday life independently. In many cases, however, irreversible residual symptoms such as problems with fine motor skills, impaired concentration, personality changes or headaches remain.

If the cerebral hemorrhage was due to increased blood pressure, the attending physician may prescribe antihypertensive drugs to prevent further bleeding in the head.

Preventive measures

To avoid traumatic cerebral hemorrhages, refer to well-known accident prevention measures (for example, wearing a bicycle helmet when cycling).

In order to reduce the risk of hypertensive intracerebral hematoma, a consistent drug treatment of high blood pressure is required. Also, all other risk factors such as diabetes, high cholesterol and obesity should be brought under control.

Furthermore, it is recommended not to smoke, to drink little alcohol, to move daily and to pay attention to a healthy diet. These measures not only contribute to the prevention of cerebral hemorrhage, but also serve a generally healthy lifestyle.

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