Cerebral Hemorrhage - Causes, Symptoms and Therapy

Dangerous bleeding in the brain

In cerebral hemorrhage, hemorrhages occur in the brain or its enveloping structures. This can lead to increased intracranial pressure and resulting neurological deficits. Depending on where the bleeding takes place, that is, in which area of ​​the skull or the brain, a distinction is made between epidural, subarachnoid and subdural hemorrhage. Bleeding in the brain is always a life-threatening affair, often with fatal outcome.

contents

• Dangerous bleeding in the brain
• causes
• Bleeding in the brain - epidural hemorrhage
• Symptoms of epidural hemorrhage
• Acute subdural haemorrhage
• Symptoms of subdural hemorrhage
• Chronic subdural haemorrhage
• Symptoms of chronic subdural haemorrhage
• subarachnoid hemorrhage
• Symptoms of subarachnoid hemorrhage
• Therapy for cerebral hemorrhages
• Preventive measures

causes

In most cases, a brain hemorrhage occurs due to a trauma, for example, a traffic accident, a fall or the like. But also diseases that affect the vascular system in the brain, high blood pressure (hypertension) or aneurysm (saccular enlargement of an artery) may be the trigger. Congenital vascular anomalies, brain tumors or vascular tumors are also among the potential causes.

Often, brain trauma occurs as a result of injury from accidents or falls. (Image: Monika Wisniewska / fotolia.com)

Certain medications, especially those designed to prevent blood clotting, can cause hemorrhage in the brain. Beneficial factors include many years of alcohol and / or drug use.

Bleeding in the brain - epidural hemorrhage

The cerebral hemorrhage takes place here in the so-called epidural space. The dura mater of the brain and spinal cord consists of two separate leaves. The outer leaf forms the so-called Periost (periosteum) and lies on the spinal canal inside.

The inner leaf is a tubular structure that surrounds the brain and spinal cord. Between these two leaves is the epidural space, which is filled with fatty and connective tissue. This protects the brain and spinal cord with every movement of the spine. The cause of an epidural hemorrhage is usually a rupture of a meningeal artery due to a skull fracture.

Symptoms of epidural hemorrhage

A "classic" epidural hemorrhage occurs so that after the injury, those affected are first unconscious for a short time. Thereafter, the patient is usually conscious and therefore also responsive for a period of a few hours. If the damage to the brain is very massive, this interval may be missing. Bleeding causes the development of a hematoma, which in turn leads to unconsciousness. A cardinal symptom is extreme headache and neck stiffness.

The patient develops half-sided symptoms, for example, a half-sided paralysis. In addition, depending on the extent of the damage, so-called intracranial signs. The skull is a bony structure that can not spread. Cerebral haemorrhage produces a hematoma, which builds up pressure. This is a life-threatening disease.

Cerebellar symptoms include increased neck and forehead headaches, dizziness, mental changes, nausea, morning, giddy vomiting, double vision, painful nerve exits, and a tendency to hiccup and yawn.

The main diagnostic tool is CT (computed tomography), which can detect bleeding, its extent and location. Rapid pressure relief from surgery is extremely important so that the tissue of the brain is not damaged.

Headache and dizziness may indicate epidural bleeding. (Image: Kurhan / fotolia.com)

Acute subdural haemorrhage

An acute subdural haemorrhage is a brain hemorrhage that develops within 72 hours, during which the blood accumulates in the subdural space. The causes for this are a craniocerebral trauma or a skull fracture. The subdural space is located between the two inner soft meninges. This is filled with cerebrospinal fluid.

Symptoms of subdural hemorrhage

The clinical symptoms of subdural haemorrhage are often indistinguishable from that of epidural haemorrhage, as the clinical picture is very similar. Even with this cerebral hemorrhage are affected immediately after the triggering event, usually an injury, unconscious. This may be followed by a symptom-free period of a few hours during which the patients are conscious and also responsive. Mostly, however, this interval is completely missing.

In any case, then develops a deep unconsciousness. At subdural hemorrhage there are semiprecious signs. Cerebral pressure signs, as mentioned in epidural haemorrhage, also occur in this form of cerebral hemorrhage. The CT also serves for diagnosis. A close monitoring of the patient and, if necessary, a possible surgical pressure relief are essential for survival.

Chronic subdural haemorrhage

Chronic subdural haemorrhage, also called chronic subdural hematoma, is a slow hemorrhage into the subdural space, in which the symptoms gradually develop over a period of two to three months.

The cause is usually a mild trauma to which the patient often does not remember, such as a bump of the head. This subsequently leads to a very slow oozing hemorrhage into the subdural space. This affects mostly older patients and people who suffer from a coagulation disorder, as is the case, for example, with alcoholics.

Symptoms of chronic subdural haemorrhage

Most of the subdural haemorrhage affects older people. You suffer from the increasing mass of the hematoma for weeks under headache, fatigue and concentration problems. This is often dismissed with weather sensitivity and not taken seriously. Personality changes are also possible.

subarachnoid hemorrhage

In a subarachnoid hemorrhage, the cerebral hemorrhage occurs between the arachnoid (spiderweb skin) and the pia mater (inner meninges). The cause of this hemorrhage is usually the rupture of a cerebral artery aneurysm, in which the hemorrhage spreads to the subarachnoid space, the space between the spiderweb skin and the inner meninges.

Subarachnoid haemorrhage is a sudden bleeding into the subarachnoid space. (Image: bilderzwerg / fotolia.com)

A cerebral artery aneurysm usually develops on the floor of a plant-related vascular wall weakness. This gradually leads to a bag-shaped extension of the affected vessel. Usually, the aneurysm at the age of forty to fifty years has progressed so far that it can burst already by a slight increase in blood pressure and subsequently develop a cerebral hemorrhage.

Other causes of subarachnoid haemorrhage include increased bleeding, leukemia, arteriovenous malformations in the subarachnoid space, metastasis bleeding and trauma. Only about thirty percent of those affected report that the brain haemorrhage preceded a special event, such as a special effort.

Symptoms of subarachnoid hemorrhage

Typical for arterial bleeding into the subarachnoid space are sudden, massive headaches in the occipital area. This is accompanied by nausea and vomiting. First, the state of consciousness is clouded, later unconsciousness occurs. Shortly before the cerebral hemorrhage, so-called warning symptoms, such as double vision, can occur.

The neurological examination of the patients shows meningism. This is a symptom complex caused by the irritation of meninges. Significant symptoms include headache, photophobia, stiff neck, hypersensitivity, nausea, vomiting, cardiac arrhythmia, increased sweating and mental changes.

As with the other types of cerebral haemorrhage already mentioned, CT is also the method of choice in order to make a diagnosis as quickly as possible. An early surgery usually brings the best results.

Therapy for cerebral hemorrhages

The time to therapy is crucial for success. The sooner treatment is given, the greater the likelihood that those affected will survive. At the slightest suspicion of cerebral hemorrhage, patients are immediately admitted to a clinic. Imaging techniques such as CT (computed tomography) and / or CT angiography allow rapid diagnosis of the location and extent of bleeding.

Computed tomography helps to detect cerebral haemorrhage as soon as it occurs. (Image: Werner / fotolia.com)

Hemorrhage in the brain reduces brain function, which usually requires artificial respiration. If there is an increase in pressure triggered by the bleeding, a surgical procedure is performed in which the hematoma is removed and an attempt is made to breastfeed it. If the event has arisen on the basis of a blood coagulation disorder, then blood preserves are administered. High blood pressure is treated with appropriate medication. In a subarachnoid hemorrhage, a hydrocephalus or a congestion of cerebral water may develop, which is treated by a neurosurgical procedure.

After the acute therapy follows the long-term treatment, a long-lasting, neurological rehabilitation. It is trying to enable those affected more and more a return to "normal" life. Years can pass before patients can live independently again, although residual symptoms often remain after cerebral hemorrhage.

Preventive measures

Some preventative measures are available to counteract the occurrence of cerebral hemorrhage. These include the reduction of existing excess weight and the normalization of excessive blood pressure. Regular exercise is important. Especially if there are strokes, myocardial infarction, high blood pressure and blood clotting disorders in the family genesis, a regular health check is recommended.

If there are already illnesses such as diabetes or hypertension, they should definitely be adequately treated with medication and regularly monitored by a doctor. A healthy, balanced, vitamin-rich and low-fat diet with a low animal content, regular exercise, relaxation exercises (for example, autogenic training or yoga) and sufficient sleep contribute to the prevention. (sw, last updated on 20.11.2017)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)