Brain Hemorrhage

brain haemorrhage is a form of stroke which occurs due to the bursting of an artery in the brain and causing localized bleeding in the adjacent tissues. This bleeding results in the destruction of various cells of the brain.

Brain haemorrhages are also known as cerebral haemorrhages, intracranial haemorrhages, or intracerebral haemorrhages and constitute about 13% of strokes.

The brain has got three membrane layers which are called Meninges, which are situated between the bony part of the skull and the actual brain tissue. These three membranes are called Dura mater, Arachnoid and Pia matter. The main aim of these meninges is to cover and provide protection to the brain. Bleeding can occur anywhere between these three membranes, i.e. either within the skull but outside of the brain tissue or inside the brain tissue. These areas are further divided as follows:

  • Bleeding within the skull but outside of the brain tissue. These comprise:
  • Epidural haemorrhage: Bleeding takes place between the skull bone and the outermost membrane layer, which is the dura mater.
  • Subdural haemorrhage: Bleeding takes place between the dura mater and the arachnoid membrane.
  • Subarachnoid haemorrhage Bleeding takes place between the arachnoid membrane and the pia mater.
  • Bleeding inside the brain tissue. These are categorized into two types, which are as follows:
  • Intracerebral haemorrhage: This bleeding takes place in the lobes, pons and cerebellum of the brain. It includes the brainstem as well.
  • Intraventricular haemorrhage: This bleeding takes place in the brain’s ventricles, which are specific areas of the brain cavities where cerebrospinal fluid is produced.

Brain haemorrhages usually happen suddenly and cause a great amount of damage to the brain and, in several cases, can prove to be life-threatening as well. The seriousness, as well as the outcome of this condition, depends on various parameters like cause, location of bleeding inside the skull, size of the bleed, the time duration between the episode of bleeding and treatment received and age of the person.

Causes

These include:

  • • High blood pressure levels
  • • Ruptured cerebral aneurysms
  • • Arteriovenous malformation
  • • Trauma to the head caused mainly due to fall or accident
  • • Cerebral Amyloid Angiopathy
  • • Bleeding disorders
  • • Overconsumption of Alcohol
  • • Brain tumour

 

Symptoms

Symptoms of this condition mainly depend on the area of the brain involved. The most commonly seen symptoms are as follows:

  • • Nausea and vomiting
  • • Slurring of speech
  • • Feeling of numbness or tingling in the extremities
  • • Difficulty in swallowing
  • • Severe headache
  • • Loss of balance and co-ordination
  • • Loss of vision
  • • Stiffness around neck
  • • Breathing difficulties
  • • Abnormal heart rate

 

Diagnosis

A thorough examination of the patient is done by the doctor, and he accordingly recommends certain tests to diagnose this condition. These tests are as follows:

  • • Complete vascular study
  • • CT scan
  • • MRI scan
  • • Spinal tap to examine the cerebrospinal fluid surrounding the brain
  • • Conventional angiography

 

Treatment

• Various treatment approaches for brain haemorrhage are as follows:

  • • These involve Anti-anxiety drugs to control blood pressure levels, anti-epileptic drugs for seizure control, painkillers for severe headaches and, in some cases, corticosteroids.
  • • These include-
  • • Endovascular treatment for SAH (subarachnoid arachnoid hemorrhage) due to aneurysm rupture- simple coiling, balloon or stent assisted coiling, flow diversion, aneurysm intrasaccular device deployment.
  • • Aneurysm clipping
  • • BrainPath surgery: Performed to remove tumours as well as blood clots.
  • • Decompression surgery releases the accumulated blood, thereby relieving pressure.
  • • Burr hole procedure: In this procedure, holes are formed in the skull so as to drain out the blood and facilitate pressure relief.
  • • Craniotomy: This procedure involves the removal of a certain area of the brain in order to drain out the blood clot, and later the removed area is placed back.

 

  • Rehabilitation treatment. It includes:
  • • Physical therapy
  • • Occupational therapy
  • • Speech therapy

 

Prevention

  • • Avoid smoking and overconsumption of alcohol
  • • Drive carefully
  • • Control blood pressure levels
  • • Wear a helmet while driving

 

Outlook

The severity of brain haemorrhage depends on the location of the haemorrhage, the extent of damage as well as age. But with the passage of time and a lot of effort, patience and determination in the rehab process, patients are able to regain various functions that had become limited or otherwise lost.