Brain Hemorrhage

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Brain hemorrhage refers to collection of blood in the brain. It is of 4 types

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Epidural hematoma(EDH)- An epidural hematoma occurs when blood accumulates between skull and the outermost covering of  brain. It typically follows a head injury, and usually with a skull fracture.

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Subdural hematoma- Subdural hematoma is a collection of blood between the surface of brain and duramater. It occurs in road traffic accidents and is associated with brain injury. A subdural hematoma is more common than other ICHs in older people and people with history of heavy alcohol use.

 

Subarachnoid hemorrhage- Subarachnoid hemorrhage occurs when there is bleeding between the brain and the thin tissues that cover the brain Arachnoid). The most common cause is trauma, but it can also be caused by rupture of a major blood vessel in the brain, such as from an intracerebral aneurysm. A sudden, sharp headache usually comes before a subarachnoid hemorrhage. The headache is worst headache of ones life.

 

Intracerebral hemorrhage also knows as HEMORRHAGIC  STROKE- Intracerebral hemorrhage occurs when there is bleeding inside the brain parenchyma. A prominent warning sign is the sudden onset of neurological deficit. The symptoms progress over minutes to hours. This mainly occurs in patients with hypertension and elderly patients.

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Causes of brain hemorrhage

• Head trauma- Head Injury is the most common cause of bleeding in the brain for those younger than age 50.

• High blood pressure Aneurysm -  It can burst and bleed into the brain, leading to a stroke.

• Blood vessel abnormalities- (Arteriovenous malformations)

• Amyloid angiopathy.

• Blood or bleeding disorders.as Hemophilia and sickle cell anemia 

• Liver disease

• Brain tumors 

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SYMPTOMS-

• A sudden severe headache

• Seizures with no previous history of seizures

• Nausea or vomiting

• Sudden tingling, weakness, numbness, or paralysis of the face, arm or leg, particularly on one side of the body

• Difficulty with swallowing or vision

• Loss of balance or coordination

• Difficulty understanding, speaking (slurring nonsensical speech), reading, or writing

• Change in level of consciousness or alertness, marked by stupor, lethargy, sleepiness, or coma

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Diagnosis

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• CT Brain

• MRI Brain

• CT Angio Brain

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Treatment-

Any type of bleeding inside the skull or brain is a medical emergency. It is important to get the person to a hospital emergency room immediately to determine the cause of the bleeding and start medical treatment. Depending upon the cause of bleeding and the amount of bleeding along with the pressure effect on the brain the patient is managed by surgery or by medical management. For SAH due to aneurysm rupture surgical clipping of the aneurysm or endovascular coiling is the treatment .

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      Stroke

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A stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.

Hemorrhagic

There are two main types of hemorrhagic stroke:

• Intracerebral hemorrhage which is bleeding within the brain itself  due to either intraparenchymal hemorrhage or intraventricular hemorrhage.

• Subarachnoid hemorrhage, which is  bleeding that occurs between the arachnoid mater and pia mater .

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Ischaemic Stroke

  In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area. The reasons for this are

1.  (obstruction of a blood vessel by a blood clot forming locally)

2.  (obstruction due to an embolus from elsewhere in the body),

3. Systemic hypoperfusion (general decrease in blood supply, e.g., in shock)

4. Cerebral venous sinus thrombosis.

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Risk factors for stroke includes:

1-Diet –An  unhealthy diet that increases the  risk of stroke is  that which is  high in:

• salt

• saturated fats

• cholesterol

2- Physical Inactivity.

3- Alcohol consumption

4-Tobacco use

5-Family history. 

Certain medical conditions are linked to stroke risk. These include:

• a previous stroke or TIA

• high blood pressure

• high cholesterol

• heart disorders, such as coronary artery disease

• heart valve defects

• enlarged heart chambers and irregular heartbeats

• sickle cell disease

• diabetes

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Symptoms

• Weakness in one side of body 

• Muscle weakness of the face

• Numbness in limbs

• Reduction in sensory or vibratory sensation

If the cerebral cortex is involved the the symptoms depend upon the lobe involved as altered voluntary movements, visual field defect , memory deficits (involvement of temporal lobe , hemineglect , lack of insight of his or her, usually stroke-related, disability.

 

Diagnosis

Stroke is diagnosed through several techniques: a neurological examination (such as the NIHSS), CT scans (most often without contrast enhancements) , MRI and angiography.

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Stroke treatment

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Stroke unit

Ideally, people who have had a stroke are admitted to a "stroke unit", a ward or dedicated area in a hospital staffed by nurses and therapists with experience in stroke treatment.

Treatment for stroke depends on the type of stroke:

Ischemic stroke and TIA

Antiplatelet and anticoagulants

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Thrombolytic drugs --.

Tissue plasminogen activator (tPA), or Alteplase IV r-tPA, is considered the gold standard in ischemic stroke treatment. It works by dissolving blood clots quickly, if delivered within the first 3 to 4.5 hours after symptoms of  stroke began.

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Mechanical thrombectomy

This surgery is most successful if it’s performed 6 to 24 hours after the stroke begins.

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Surgery

This may be done with a catheter, or if the clot is especially large.

Hemorrhagic stroke

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For intracerebral hemorrhage surgery is required if there is large clot with mass effect and midline shift. In subarachnoid hemorrhage, early treatment for underlying cerebral aneurysms may reduce the risk of further hemorrhages. Depending on the site of the aneurysm this may be by surgery that involves opening the skull or by endovascular route.

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