A cerebral hemorrhage is caused by the rupture of a blood vessel (usually an artery in the brain) that causes bleeding in or around the brain.
Bleeding in the brain caused by vascular rupture is called hemorrhagic stroke (all bleeding inside the brain is called intracranial).
As a rule, bleeding inside the skull or brain occurs suddenly, regardless of the cause.
Cerebral hemorrhage can:
- damage brain cells very quickly,
Since the brain cannot store oxygen, there is a network of blood vessels to supply it with:
With heavy bleeding, the intracranial hematoma causes pressure on the brain, which blocks the arterial blood supply.
If arterial blood flow is interrupted for at least three or four minutes, brain cells die.
The consequences can be:
- A loss of motor and cognitive skills,
The hematoma is a mass of blood that can form due to damage or rupture of blood vessels in the brain.
Types and symptoms of cerebral hemorrhage
The cerebral hemorrhage can be classified:
- According to the locality of bleeding,
- According to the intensity of organ damage.
The nature of bleeding can be determined by various diagnostic examination methods.
Bleeding inside the brain tissue (parenchyma) causes intraparenchymatous or intracerebral hemorrhage, which occurs mainly in the elderly.
- Symptoms of intracranial hypertension depend on the extent of bleeding, it can be:
- gush vomiting,
- Bradycardia (due to pressure on the bottom of the fourth ventricle of the brain).
- Loss of alertness: can occur with bleeding in the area of the bridge or thalamus, but can also only show up after a certain time, when the bleeding spreads to the ventricles and leads to a blockage of the cerebrospinal fluid circulation, thus obstructive hydrocephalus
In case of bleeding, the headache is very strong, while in the case of a tumor it is weaker.
Spontaneous intracerebral hemorrhage is not caused by an aneurysm or malformations.
It is very closely related to arterial hypertension and other causes, such as:
- coagulation disorders,
- thrombocytopenia (very rare),
- Formation of new blood vessels after ischemia.
This is the most common cause of cerebral hemorrhage.
Hemorrhage can also affect the ventricles in the brain that contain the cerebrospinal fluid.
In this case, it is called intraventricular hemorrhage.
This disease has a high incidence in premature babies, who suffer mainly from:
- respiratory distress syndrome,
- pulmonary collapse,
Intraventricular bleeding is more common in the first 48 hours after birth.
Primary intraventricular hemorrhage is found throughout the cerebral ventricular system.
Reasons for this can be:
- intraventricular trauma,
- vascular malformation,
70% of intraventricular bleeding is secondary, it is the extent of a hemorrhage in the brain tissue.
Intraventricular hemorrhage is a major risk factor for cerebral palsy.
A serious variant is 4th degree ventricular hemorrhage, in which the blood:
- breaks into the lateral ventricles,
- passes into the third ventricle,
- Dilates the sylvii aqueduct and the fourth ventricle,
- Leaves the subarachnoid space through the hole (or foramen) of stomach or luschka.
In the end, the entire cerebral cortex is covered with blood, which arrives with the cerebrospinal fluid.
Subarachnoid hemorrhage (SAB) is a serious condition in which there is bleeding into the subarachnoid spaces outside the pia mater.
It is typical for young people aged 20-30-40.
The most common cause is the rupture of an aneurysm.
The risk of rupture is proportional to the size of an aneurysm.
The severe headache can also occur in the case of non-bleeding aneurysms (6.3% of cases).
In most cases, rupture of the aneurysm occurs over time.
Location of aneurysms: they are located mainly on the superficial arteries of the brain, at the level of the circulus arteriosus Willisii.
These aneurysms are usually acquired and form mainly where a cerebral artery splits, because here the artery has less resistance.
The risk of rupture is high if the neck of the aneurysm is disproportionate to its base, while a spindle-shaped aneurysm has a lower risk of rupture.
Other causes of SAB (much less common) include:
- rupture of arterio-venous malformation,
- Rupture of an angioma (blood sponge).
The most common cause of SAB is trauma, but it can also occur spontaneously. In this case, the symptoms are:
- Sudden and very severe headache. As a rule, the patient describes them as if it were “the worst headache of his life”. The doctor must suspect an aneurysm if the patient says that the pain resembles a stabbing or something terrible.
- Other sudden symptoms such as sudden loss of consciousness.
The subdural hematoma is located between the arachnoid and dura mater.
Subdural hematoma is the most common type of traumatic blood loss (even mild form).
Often the patient is in a coma upon admission to the hospital.
Epidural hemorrhage occurs between the hard meninges and cranial bones, it may be caused by cranial trauma that causes rupture of the meningeal artery or one of its branches.
In 90% of cases, this type is the result of a skull fracture:
- In children,
- In adolescents.
Since the brain tissue under the hematoma is usually only slightly affected, the prognosis is good with early treatment.
In such cases, mortality is about 5%.
Classification and consequences of bleeding according to its localization
- The typically localized cerebral hemorrhage occurs in the deep area, for example, in the thalamus.
Bleeding in the corpus striatum – depending on the hemisphere of the brain
- hemiplegia (paralysis of the right or left side of the body),
- loss of sensitivity on one side of the body,
- Aphasia or loss of speech (if the damage is on the left side).
- Neglect or difficulty seeing a space opposite the lesion (if the damage is on the right side).
- Impaired consciousness (at the beginning).
- hemianesthesia: loss of sensation on the opposite side of the body (also on the face),
- hemiplegia / hemiparesis,
- deviation of the eyeballs downwards,
- Anosognosia (inability to recognize one’s own disease) and aphasia.
Bleeding in the bridge
This is a very serious situation, because it takes place near the bulb cerebri.
- Sudden coma, the prognosis is often infaust.
If the patient survives, the following may develop:
- Miosis (narrowing) of the pupils,
- Restricted eye movements to the right or left (if the VI cranial nerve is affected).
Cerebellar hemorrhage (cerebellar hemorrhage) tends to worsen very quickly because there is pressure in the posterior cranial fossa.
This can cause:
- displacement of cerebellar tonsils,
- A bulb compression.
The consequences can be:
- Cardiac arrest
- Respiratory block.
In this situation, a pressure-relieving neurosurgical intervention is required.
- nausea, vomiting and severe headache,
- coma (within a few hours),
- Possible paralysis of the VII cranial nerve.
- Cerebral hemorrhage with atypical localization is more superficial, which can be in the frontal, parietal or occipital lobe.
It can occur unilaterally (right or left side of the brain) or on both sides.
Bleeding into a lobe of the brain
Examples of atypical localization are:
- Cerebral cortex
- White temporo-parieto-occipital substance.
Sometimes this can cause mild symptoms.
The causes of bleeding in this case are other diseases:
- vascular malformation,
- amyloid angiopathy,
- Tumors: glioblastoma multiforme, which is a particularly malignant glioma,
Symptoms of extensive cerebral hemorrhage
The symptoms only arise when the cerebral hemorrhage is sufficiently large and presses on the brain.
Signs and symptoms of this dangerous disease can vary depending on the severity and localization of the bleeding.
The most common symptoms may include:
- Sudden and severe headache that can last for days;
- General weakness of the body and lethargy;
- Sudden epileptic seizures;
- Loss of consciousness;
- numbness or tingling;
- nausea, sometimes followed by vomiting;
- loss of motor skills and tremor of the hands;
- Loss of balance and coordination.
Consequences of cerebral mass hemorrhage
If a person suffers a cerebral mass hemorrhage, serious complications can occur.
Depending on the location of the cerebral hemorrhage, the consequences can be:
- loss of communication skills,
- swallowing disorders,
- Loss of vision.
- loss of sensitivity and paralysis of one side of the body,
- cognitive dysfunction (memory loss, difficulty concentrating),
- mental confusion,
- Depression, emotional disorders..
- Cerebral hemorrhage: causes and therapy | Coma and death
- Ischemic or hemorrhagic stroke: symptoms
- Craniocerebral trauma: symptoms, consequences and therapy