Cerebral Hemorrhage

Cerebral hemorrhage is the rupture of a blood vessel (generally an artery in the brain) leading to bleeding and brain damage. It has different forms like:

• Intracerebral hemorrhage : There is bleeding in the brain. Depending on the size and location of the bleed, the symptoms and prognosis varies
• Subdural hemorrhage : There is bleeding between the layers of the brain's covering or meninges
• Subarachnoid hemorrhage : There is bleeding between the brain and the membranes that cover the brain
• Epidural hemorrhage : There is bleeding between the covering of the brain and the skull

Causes of Cerebral hemorrhage

• Head injury : In case of those, whose age is less than 50, this is the usual reason for hemorrhage in the skull. In case of elder people, subdural hematoma following minor head injury is common
• Hypertension : If hypertension is not properly controlled for a long period of time, the blood vessel walls are weakened and the risk of intracranial bleeding increases
• Aneurysm : The blood vessel swells and the blood vessel wall weakens. The thin walls of an aneurysm may burst and lead to bleeding in the subarachnoid space and the brain
• Arteriovenous malformation : An anatomical abnormality in the arteries or veins in or around the brain may be congenital, but can be detected only if symptoms develop. Depending on the size and location of the bleeding, the symptoms vary
• Amyloid angiopathy : This abnormality in the blood vessel walls increases with aging. There are small, asymptomatic hemorrhages followed by a large symptomatic one

Symptoms

• loss of consciousness
• nausea and vomiting
• sudden headache
• steadily increasing neurologic losses like numbness, weakness, inability to move (paralysis), loss of speech or vision, confusion
• seizures : these are uncontrolled physical movements

Diagnosis
The computed tomography (CT) scan of the brain is used to conclude the results. A lumbar puncture (spinal tap) is used to confirm subarachnoid hemorrhage. This also assists in identifying infection of the brain or its covering layers. Magnetic resonance imaging (MRI)/MRA, CT angiogram and/or contrast angiography is felt essential to complete the diagnosis.

Treatment
The abnormality that caused the bleeding, the location of the bleeding and the size of the blood clot are the deciding factors for the treatment. Diagnostic radiology comprises of different scans to exactly detect the nature and location of the hemorrhage. Interventional radiology consists of treatments in which a catheter is passed to widen or close off blood vessels in the brain, without surgery. Other types involve focused radiation to amend irregular blood vessels that have been bleeding. Microsurgical techniques are employed to treat abnormal or leaky vessels.

Complications

• Stroke : occurs when the blood supply to the part of the brain is abruptly interrupted or when a blood vessel in the brain bursts and spills blood in the space surrounding the brain cells. It is also called as a "brain attack".
• Temporary or permanent brain damage
• Cerebrovascular accident : takes place when the blood supply to the brain is hindered. The result is cell injury and death

Bleeding in the brain
Internal bleeding can take place in any part of the brain. Blood can gather in the brain tissues or in the space between the brain and the membranes covering it. If the bleeding is confined to one hemisphere it is called "lobar intracerebral hemorrhage". If it takes place in the cerebellum, it is called "deep intracerebral hemorrhage". Bleeding may also occur in the pons, basal ganglia or the thalamus. When bleeding takes place due to high blood pressure, it is called "hypertensive intracerebral hemorrhage". The swelling caused due to irritation of brain tissues by the blood is called "cerebral edema". The blood collects into a mass called "hematoma". Cerebral edema or hematoma raises the pressure on brain tissues and destroys them at a rapid rate.