Intracranial hemorrhage (i.e., 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 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 ICH but is more commonly associated with epidural and subdural hematomas.
Intracranial hemorrhage has several causes, including:
- Cranial trauma is 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 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 blood vessel wall that bulges and bursts).
- Accumulation of the amyloid protein within the walls of the brain’s arteries (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
- The 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.
- The problem 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 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 for the following situations:
If the bleeding is caused by a broken artery, it requires immediate brain decompression 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 the cranial cavity).
Bleeding 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 remedies are necessary to control 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.