Intracranial hemorrhage (ie the pathological accumulation of blood within the cranial vault) can occur within cerebral parenchyma or the surrounding meningeal spaces, accounting for 8 to 13% of all traces and results from a broad spectrum of disorders.
All intracranial hemorrhages (ICH) share some classic clinical features. Common symptoms that include headache, nausea, vomiting, confusion, drowsiness or seizures. Patients may be not alert and moribund.
In elderly alcoholics and anticoagulated patients, even minor trauma can result in devastating intracranial hemorrhage. This trauma can precede any type of ICH, but is more commonly associated with epidural and subdural hematomas.
Intracranial hemorrhage has a number of causes, including:
- Cranial trauma, such as caused by a fall, car accident, sports accident, etc.
- Damage of hypertension (high blood pressure) to the walls of the blood vessel that causes leakage or rupture of the blood vessel.
- Blockage of an artery in the brain by a blood clot that forms in the brain or travels to the brain from another part of the body, with subsequent output from the damaged artery.
- Brain aneurysm rupture (a weak point in the wall of the blood vessel that bulges and bursts).
- Accumulation of the amyloid protein within the walls of the arteries of the brain (cerebral amyloid angiopathy).
- Leakage of malformations of the arteries or veins (arteriovenous malformation).
- Treatment with anticoagulants (blood thinners).
- Bleeding of tumors.
- Smoking, excessive consumption of alcohol or use of illegal drugs such as cocaine.
- Conditions related to pregnancy or childbirth, such as preeclampsia, postpartum vas deferens or neonatal intraventricular hemorrhage .
Symptoms of intracranial hemorrhage
- Sudden sensation of tingling, weakness, numbness or paralysis of the face, arm or leg, especially on one side of the body.
- Sudden and intense headache
- Difficulty to swallow
- Sight loss
- Loss of balance or coordination.
- Difficulty in understanding, speaking, reading or writing.
- Change in the level of consciousness or alertness, marked by stupor, lethargy, drowsiness or coma
If a stroke has occurred, the cause (bleeding or blood clots) must be determined in order to start the appropriate treatment. Timely medical treatment can minimize damage to the brain, thus improving the patient’s chance of recovery.
Surgery is necessary in the following situations:
If the hemorrhage is caused by a broken artery, it requires immediate decompression of the brain to release pooled blood and repair damage to the blood vessels. Decompression can be done through a burr hole procedure, an incision, craniectomy or a craniotomy (opening of the cranial cavity).
Hemorrhage caused by a cerebral aneurysm requires aneurysm clipping through a surgical craniotomy procedure, as long as it allows the patient’s neurological condition.
Other treatments may include:
- Anxiolytics or medications to control blood pressure.
- Antiepileptic drugs for the control of seizures.
- Other medications necessary for the control of other symptoms, such as analgesics for severe headache pain and decalcifiers to prevent constipation and straining during defecation.
- Nutrients and liquids as needed. These can be given through a vein (intravenous) or tube feeding in the stomach, especially if the patient has difficulty swallowing.