Cerebral hemorrhage is a common name given to intracranial bleedings.
There are several reasons that can cause cerebral bleeding and the life-threat which develop due to bleeding depends on the reason for bleeding, its location and amount.
Cases which lead to cerebral hemorrhage:
1-Trauma is the injury of the head. Cerebral hemorrhages may be in different types and compartments depending on the location of the impact and the damage it causes (bone fracture, brain tissue injury, vascular injury).
2- Hypertension: Hemorrhage may develop within the brain tissue or meninges as a result of elevated blood pressure.
3- In relation with the vascular disease, cerebral hemorrhages developing in conditions such as aneurysm causing weakening on vascular wall generally occur between meninges.
4-May develop as a result of obstruction within the small or main vascular structures of the brain.
5- Hemorrhage may develop within the brain tissue which was injured due to insufficient blood flow or other reasons.
6-Intra-tumor bleedings may develop in some brain tumors.
7- Cerebral hemorrhages may appear in some blood diseases as well as they develop in other organs of the body.
HOW MANY TYPES OF CEREBRAL HEMORRHAGES ARE THERE?
Same as they are classified according to above-mentioned bleeding reasons (Traumatic, hypertensive, aneurysmal intratumoral venous bleeding), cerebral hemorrhages may be classified also according to which compartment they develop
1-Inrracerebral hemorrhage: is the bleeding within brain tissue
2-Intraventricular hemorrhage: is the bleeding within the spaces filled with water in the brain (ventricles)
3- Epidural hemorrhage: is the bleeding that occurs in the space between outer layer of the membrane covering the brain and the skull Usually occurs as a result of head trauma and fractures.
4-subdural hemorrhage: is the bleeding between the membranes covering the brain. Whereas it may be related to trauma, vascular injury, blood disease, reduced intracranial pressure, it may also develop spontaneously.
5- Subarachnoid hemorrhage: is the bleeding that develops between the innermost layer of the membrane that surrounds the brain and the middle layer. Also may be due to trauma or infection.
The most practical method used to examine brain hemorrhage is "computed tomographic imaging" (CT). In some cases, "magnetic resonance imaging " method can be used.
Cerebral hemorrhage is one of the most urgent and risky situations. This situation, which can lead to death or paralysis in a short time, may require emergent surgery. However, it may not be necessary to perform emergent surgery for every cerebral hemorrhage. Time and method of treatment may vary depending on the location, amount and the cause.
Brain Attack Symptoms
Brain attack can be seen in two types:
I - Transient Ischemic Attack:
Findings can resolve in a few seconds or it can take up to 48 hours.
Transient ischemic attack symptoms may include:
Vision loss: can be single-sided or double-sided.
Double vision: is defined as double vision or blurred vision
Dizziness: initially, the patient feels strangeness and then feels as if he/she’s turning around.
Difficulty in swallowing: In case difficulty in swallowing is very remarkable, there is risk for liquid or foods to pass to the respiratory tract (aspiration).
Weakness: is weakness in single or double-sided arm and / or legs. Facial paralysis can be seen, too.
Sensorial disorder: are seen as single or double-sided. Numbness or burning-like feeling occurs in the Face, arms, legs and body.
Speech disorder: difficulty in remembering words, pronunciation or understanding what is being said can be seen.
Coordination Disorder: Movements of arms, legs or the body are out of balance. The patient may stagger or fall while walking or standing.
Behavioral disorder: The patient becomes insensitive to what being said or perform incompatible actions.
Excessive drowsiness may occur.
Agitation or psychosis may be seen.
This definition is used if the findings mentioned above sustain more than 48 hours.
The Importance of Time in Brain Attacks
Nerve cells, are the most sensitive cells of the human body to remain anemic. Nerve tissue (brain and spinal cord) remaining bloodless even for a short period of time suffers irreversible damage. The tissue fed by the occluded cerebral artery, completely dies within a few hours, and irreversible damage develops. There is a peripheral tissue whose nutrition has decreased considerably around the damaged area and the emergent stroke treatments often re-enables enough blood access to this tissue and keep the damage minimum.
The treatment of the tissues which are such sensitive to the absence of oxygen or anemia should be initiated as "in the shortest possible time" in order to rescue the tissue as much as possible. Here, the version of the adage widely used by people in the community should be accepted as “The time is brain”. Reaching to an appropriate hospital after the occurrence of the complaint and initiating the treatment as soon as possible is vital.
Transient ischemic attack, is not a simple and harmless event to be neglected. It may be a precursor of impending stroke. Not noticing or giving attention to this important finding may take the chance surviving from death or permanent disability that may occur in the following days. Risk of stroke is approximately 10 % within 90 days following to transient ischemic attack. Half of these cases occur approximately in the first 1-2 days.
Patients who had transient ischemic attack should be monitored under emergency intensive care conditions. In cases of admitting to emergency service within the first hours, thrombolytic therapy should be administered to eligible patients following to detail clinical and laboratory examination and evaluation. "Thromboembolic therapy" is the administration of clot melted drug intravenously or via angiography method to the vascular area where occlusion developed. The brain need to be examined with computed tomography before administering this treatment. The scope of this examination is to make differential diagnosis between stroke related to occlusive vascular disease and cerebral hemorrhage whose clinical and physical examination findings are very similar to each other. Which disease is the factor should be definitely determined because the treatment of these is quite the opposite. Transient ischemic attacks accidentally can be interpreted as migraine, seizures, peripheral neuropathy or anxiety.
Transient Ischemic Attack
Transient ischemic attack symptoms may include:
- Vision loss: can be single-sided or double-sided.
- Double vision: is defined as double vision or blurred vision
- Dizziness: initially, the patient feels strangeness and then feels as if he/she’s turning around.
- Difficulty in swallowing: In case difficulty in swallowing is very remarkable, there is risk for liquid or foods to pass to the respiratory tract (aspiration).
- Weakness: is weakness in single or double-sided arm and / or legs. Facial paralysis can be seen, too.
- Sensorial disorder: are seen as single or double-sided. Numbness or burning-like feeling occurs in the Face, arms, legs and body.
- Speech disorder: difficulty in remembering words, pronunciation or understanding what is being said can be seen.
- Coordination Disorder: Movements of arms, legs or the body are out of balance. The patient may stagger or fall while walking or standing.
- Behavioral disorder: The patient becomes insensitive to what being said or perform incompatible actions.
- Excessive drowsiness may occur.
- Agitation or psychosis may be seen.
There are two main reasons of the stroke which develops related to vascular occlusion:
-Cardio embolic stroke: The clot which develops inside cardiac chambers due to irregularly working heart muscles, deficient cardiac rhythm (the arrhythmia, atrial fibrillation) may access brain vessels and lead occlusion.
-The stroke which develops related to stenosis or occlusion in the neck or its muscles.
In either case, primary treatments are similar due to occlusion in cerebral vessels. But it differs in protective treatment for the next attacks.
In order to examine the cause of the stroke which develop related to occlusive vascular disease, it is necessary to examine the neck and cerebral vessels as well as the heart.