What is intracranial hemorrhage?
It is s term used for bleeding inside the skull, in comparison to the bleeding outside the skull like a bruise on the scalp. This writing mostly addresses its one type, the intracerebral hemorrhage.
What are different types of intracranial hemorrhage?
- Bleeding of an artery inside the brain, the intracerebral hemorrhage (ICH)
- Bleeding of an aneurysm, the subarachnoid hemorrhage (SAH)
- Bleeding of a vein outside the brain, the subdural hemorrhage (SDH)
- Bleeding of an artery outside the brain, the epidural hemorrhage
- Bleeding within a tumor inside the brain
- Bleeding caused by an arteriovenous malformation (AVM)
- Bleeding caused by leaky small blood vessels, usually when patient has a bleeding disorder or is taking a strong blood thinner
What is the most common type of intracranial hemorrhage?
The most common type is an intracerebral hemorrhage or an ICH.
What is the cause of an ICH?
ICH is typically caused by high blood pressure or HTN. HTN can cause a sudden bleed if the pressure is very high by rupturing a small or medium sized artery inside the brain. Even mild to moderate HTN left untreated can make small and medium sized brain blood vessels weak or fragile, which can easily rupture if the pressure goes up. There are many other causes of ICH, all ultimately making the blood vessel weak and then puncturing it.
What are the symptoms of ICH?
The most common symptom is a headache, usually appearing relatively quickly. Other common associated symptoms are dizziness, nausea, vomiting, stroke like symptoms (numbness, weakness, difficulty speaking, visual loss, double vision, etc.) or a seizure.
What should one do in case of ICH type symptoms?
Seek immediate medical help, call 911, and try to be in emergency room ASAP. Do not take an aspirin or any blood thinner. In case of stroke like symptoms, it is never a good idea to take aspirin or any blood thinner without knowing the type of stroke. For example, if the stroke is caused by a bleed, a blood thinner can make it worse.
How is ICH diagnosed?
Diagnosis of ICH requires brain imaging, ideally a CT scan without contrast.
How is ICH treated?
In most cases of ICH, there is no specific medicine to stop the bleeding. In most cases though, the bleeding stops itself by building a clot around the leaked blood vessel. But following measures can be very useful to minimize injury to the brain:
A: ABC: The first measure is to make sure that the patient’s airway is clear from any obstructions, such as dentures falling backwards or vomitus blocking the airway. The step after is to maintain appropriate breathing and oxygenation. After that is the circulation, making sure the blood pressure is not too low or too high.
C: Stat head CT
C: In most patients, proper blood pressure management is critical, but this matter is not a straightforward issue. While high blood pressure is harmful in this condition, aggressively lowering the blood pressure can also be damaging to the brain around the clot resulting in worsening of an already bad situation. This is an active area of research for a variety of patients.
D: In case patient is on a blood thinner, its antidote, if available can be used to stop further bleeding.
E: Blood tests, EKG, chest Xray, or any other pertinent test
E: Formal assessment by a neurologist or a neurosurgeon to find the best course of action. This is a complicated decision-making process after reviewing all the clinical and lab data. Most patients are admitted in hospital but do not require any surgical intervention, which is helpful in only a select group of patients. If indicated, surgery is performed urgently to remove the clot, which helps to minimize damage to the surrounding brain. The level and extent of surgery depends upon the size and location of the bleed.
What is the prognosis of ICH?
Its prognosis depends upon many factors, but mainly upon its size and location in the brain. Some bleeds can be minor with minimal symptoms and its complete or almost complete resolution. Many others can be terribly devastating, either resulting in significant disability or death.
What are the complications of ICH?
It depends upon the size and location of the bleed, and any underlying previous medical issues, including any previous brain problems. Common complications are weakness (e.g., hemiparesis), difficulty speaking, walking, balancing, controlling bladder, cognitive problems, seizures, pain, insomnia, and depression.
Is there any stem-cell based treatment for ICH?
Though an idea for this type of treatment has been conceived and minimally tested, no such treatment is available at this time. It requires further scientific development and testing.
Can the brain regrow the area lost by a stroke?
In physical sense, there is no evidence that the brain can regrow an area lost by an injury or stroke. To a certain extent, it can rewire its circuitry. This capacity of rewiring is better in younger age.
What is the role of physical therapy after ICH or a stroke?
Physical therapy can help to maintain an already affected function, such as dexterity, strength or balance. It probably also helps the brain to rewire itself.
What is the role of occupational therapy after ICH or a stroke?
This type of therapy can help to figure out better living with new reality with a disability. For example, it can help to properly use a cane or a walker, a prosthesis if a hand is affected, or a communication device.
How to prevent ICH?
Probably the best advice is to pay attention to the blood pressure and properly control it if high. If taking a medicine for high blood pressure, make sure it is working and the blood pressure is properly controlled. Depending upon the cause, in some other situations, specific preventive measures may be needed.
Where can I get more information about ICH?
American Association of Neurological Surgeons
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