Cerebral Hemorrhage

What Is Cerebral Hemorrhage?

"Cerebral hemorrhage" is, from a medical point of view, the colloquial term for bleeding inside the skull (intracranial), in the area of the brain (intracerebral), and the location of the meninges (extracerebral). Typically, intracerebral hemorrhages in the brain are referred to as cerebral hemorrhages. Annually, about 10-12 out of 100,000 inhabitants in Germany suffer an intracerebral hemorrhage. Intracranial hemorrhages include, for example, epidural hematoma; extracerebral hemorrhages include subdural or subarachnoid hemorrhages.

In ischemic stroke, which causes similar symptoms to intracerebral hemorrhage, ischemic damage (lack of oxygen supply) destroys brain tissue. In intracerebral hemorrhage ("bloody stroke"), brain tissue is damaged by hemorrhage. 10-17% of strokes are caused by intracerebral hemorrhage.

Since the brain is located within the skull bone, it cannot expand with volume increase. Therefore, when bleeding occurs within the brain, the volume increases and the pressure on the brain tissue. The increased pressure on the brain's nerve cells damages and destroys them.

What Causes Cerebral Hemorrhage?

Due to years of high blood pressure, long-term changes in the vessels with weak points (arteriolosclerosis) occur. These weak spots can rupture, usually suddenly, and cause symptoms within a very short time. In addition to the leading cause of hypertension, 70-80% of patients manifest this, accidents, tumors, coagulation disorders, or vascular changes such as aneurysms (vessel wall bulges) or amyloid angiopathy (abnormal protein deposits in the brain vessels) can also cause bleeding within the brain. More patients, especially older ones, are now taking anticoagulant medications, which can play an essential role in developing cerebral hemorrhage. Anticoagulant medications such as Marcumar (Phenprocoumon) increase the risk of bleeding in the brain by 8-10 times.

Smoking, drugs, and excessive alcohol use further increase the risk of intracerebral hemorrhage.

What Are the Symptoms of Cerebral Hemorrhage?

The symptoms of cerebral hemorrhage manifest like those of a stroke.

Those affected suddenly show speech and motor impairments often accentuated on one side and may also exhibit clouding of consciousness, even coma. The majority of patients also complain of nausea, vomiting, and headache.

Intracerebral Hemorrhage: Chances of Survival and Recovery

Intracerebral hemorrhages represent life-threatening emergencies that require rapid action. Since increasing pressure within the hemorrhage causes further damage to the brain with each passing minute, immediate action with the fastest possible transport of the patient to the hospital is essential.

Neurosurgical intervention may be necessary to relieve the pressure on the brain from the hemorrhage and stop the bleeding.

Since the symptoms of intracerebral hemorrhage are indistinguishable from those of ischemic stroke and the therapies, however, are opposing, carrying out an imaging procedure (CT or MRI) is crucial for accurate and, above all, prompt diagnosis. Usually, a computed tomography (CT) is carried out to deliver a quick result.

Acute therapy consists of nonoperative and neurosurgical therapy regimens, depending on the individual case. Nonoperative, accurate control of blood pressure is incredibly crucial. Surgical, which means neurosurgical interventions to relieve intracranial pressure, are necessary primarily when consciousness is impaired or the extent of hemorrhage increases. After intracerebral hemorrhage, the risk of epileptic seizures increases due to brain damage. In addition, one of the major complications after cerebral hemorrhage is rebleeding, which occurs in nearly 40% of patients in the first 24 hours after the acute event.

Survival from intracerebral hemorrhage depends primarily on the size and location of the hemorrhage. For example, with a hemorrhage volume of more than 60 ml of blood in low-lying hemorrhage, about 93% of patients die; with a hemorrhage of less than 30 ml of blood in a comparable location, only 23% die. Overall, studies show that within the first month after cerebral hemorrhage, 35-52% of patients die, and only 20% of patients no longer require support six months after the hemorrhage incident. In addition, most of those affected show late damage, such as motor, speech, or cognitive impairments, during the event.

What Happens Next? – Rehabilitation After Cerebral Hemorrhage

If patients have been stabilized after the acute phase of the disease, rehabilitative measures are initiated at an early stage, often still in parallel with intensive medical care. Since the human brain can recover lost functions and compensate for damage to brain structures with healthy nerve cells, close and early care by neurologically experienced specialists is important.

Which Treatment Are Carried Out During Rehabilitation after Cerebral Hemorrhage?

During neurological rehabilitation, patients receive support for motor functions, speech, cognitive and other impairments. The therapists providing care (physicians, physical therapists, occupational therapists, speech therapists, psychotherapists, etc.) usually work closely together as an interdisciplinary team to achieve the best possible outcome for patients. Since the impairments in patients after intracerebral hemorrhage can be very individual, a patient-centered, personal development of the therapy plan always takes place.

Depending on the extent of neurological limitations, rehabilitative care may vary in length. Most inpatient stays are 6-8 weeks. Continued rehabilitative aftercare to maintain success can often be provided in outpatient settings.

Which Rehabilitation Clinic Is Recommended after Cerebral Hemorrhage?

After an intracerebral hemorrhage, it is recommended that patients undergo neurological rehabilitation, as the corresponding clinics are best equipped for these patients and their requirements. It is also advisable to turn to specialists with many years of experience. One of the leading rehabilitation clinics for neurological patients in Switzerland is cereneo, under the direction of our specialist Prof. Luft.

Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively and a reliable doctor would never claim to be the best one, we can only rely on the doctor's experience.

We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in brain hemorrhage and are awaiting your inquiry or treatment request.

Sources:

• www.dgn.org/leitlinien/2370-ll-28-2012-intrazerebrale-blutungen (Stand 21.10.2019)
• de.wikipedia.org/wiki/Hirnblutung (Stand 21.10.2019)
• dey.wikipedia.org/wiki/Intrazerebrale_Blutung (Stand 21.10.2019)