Cerebral Hemorrhage • Symptoms & Chances of Recovery

At a glance:

Stroke: recognizing harbingers and acute symptoms

Symptoms of a cerebral hemorrhage

Many symptoms of cerebral hemorrhage are the same in stroke, regardless of whether it is caused by a vascular occlusion or a cerebral hemorrhage. Typically the symptoms appear suddenly and suddenly. Severe headaches as well as nausea and vomiting are specific to cerebral haemorrhage. Depending on which region of the brain is impaired, further complaints can occur:

• Sudden imbalance disorders – typical falls, for example
• Unilateral paralysis and numbness, either of the arm and hand or of the leg and foot
• unilateral paralysis of the face (often the corner of the mouth hangs down)
• Problems speaking and difficulty swallowing
• Word finding disorders
• Visual disturbances: sudden unilateral blindness, blurred or double image
• confusion

In the event of these symptoms, those affected or their relatives should call the emergency doctor immediately! Even if the symptoms subside after a short time, a doctor should definitely check the state of health. Short-term symptoms often herald a major stroke.

In women, the symptoms are not always as clear as they are in men. Therefore, relatives and friends should pay particular attention to them and also take symptoms such as impaired consciousness, confusion or pain in connection with the above-mentioned symptoms seriously.

Typically, the longer the symptoms last, the more severe the long-term effects. That is why fast, expert help in the hospital is crucial.

What is a cerebral hemorrhage?

A cerebral hemorrhage is a subtype of stroke and is responsible for around ten to 15 percent of cases. It represents a considerable danger for those affected and should be treated by an emergency doctor as soon as possible. Every minute counts here. Experts assume that ten to 30 out of 100,000 people in Germany suffer from a cerebral haemorrhage during one year. Anyone who suffers from high blood pressure is at a greatly increased risk of cerebral haemorrhage.

Depending on the area in which cerebral hemorrhage occurs, there are different subtypes:

• Intracerebral haemorrhage (intracerebral hematoma): A blood vessel has burst in the brain tissue.

• Epidural haemorrhage (epidural hematoma): As a result of trauma (external blow, fall), blood escapes between the outermost meninges and the skull bone.

• Subdural hemorrhage / subarachnoid hemorrhage: This is where the blood collects between different layers of the meninges.

Intracerebral bleeding is further subdivided by medical professionals. If other underlying diseases are the cause, there is secondary intracerebral bleeding. Basic diseases can be:

• Vascular diseases and malformations
• Thrombosis
• Clotting disorders
• Drug / substance abuse
• Inflammation of the lining of the heart

If there is no explanation as to why bleeding occurs in the brain, it is classified as spontaneous intracerebral bleeding. However, it makes no difference in treatment.

Cerebral haemorrhage: causes high blood pressure and falls

When a brain hemorrhage occurs, blood leaks from the blood vessels in the brain. Usually high blood pressure (hypertension) is the cause. This can lead to a blood vessel rupturing – especially if there are other risk factors or if the elasticity of the tissue has decreased over the years.

If the blood vessels are already damaged by another disease, such as arteriosclerosis (hardening of the arteries), the risk of a stroke increases. Then the vessel wall can no longer withstand the pressure inside and a hole is created. Great physical exertion can also lead to an increase in pressure in the vessels, which can cause cracks in already pre-stressed vessel walls.

Such bleeding is also typical after falls or collisions with the head. Then they can usually be found between the layers of the meninges. This bleeding can continue for up to twelve hours after an impact.

A basic problem of a cerebral haemorrhage is the pressure that is created by the leaked blood in the brain and destroys the healthy brain tissue around it. On the other hand, some regions of the brain are not adequately supplied with oxygen and nutrients when the blood can no longer find its way through the vessels.

The risk of a stroke increases with age: half of all stroke patients have passed the age of 70. Men are affected slightly more often than women.

Diagnosis of a cerebral hemorrhage

It is very important for the doctor to find out whether a bleeding in the brain or a blockage of a blood vessel by a clot (ischemic stroke) is the cause of the symptoms. Because both cases have to be treated very differently, but show up through the same symptoms. Only with the help of computed tomography (CT) or magnetic resonance imaging (MRI) of the brain can the treating doctor differentiate between the two diseases. Because there he sees in the pictures which vessels have been damaged and how much. In some cases the doctor needs an even more precise representation of the brain vessels. The following procedures are used for this:

• Computed Tomographic Angiography (CTA)
• Magnetic resonance imaging angiography (MRA)
• Digital subtraction angiography (DSA, rarely used)

Tests for blood coagulation (determination of platelets) and for inflammatory processes are also part of the acute diagnosis. If these procedures do not yet reveal the cause, the doctor can order further tests, such as drug screening, the search for markers for vascular inflammation or a genetic test.

This is how it continues after a brain hemorrhage

If you have a stroke caused by cerebral hemorrhage, you should go to a clinic as soon as possible – preferably one that specializes in strokes. Since high blood pressure is the cause in around 80 percent of cases of cerebral hemorrhage, the most important treatment measure is lowering blood pressure with medication. Anyone who takes blood-thinning medication should stop taking them. For some of these drugs there are antidotes that counteract the blood-thinning effect. Doing this, medical professionals try to stop the bleeding. It is helpful if someone in the hospital can provide information about what exactly happened.

In many cases, spontaneous surgery is also required to remove the blood and its clots and to stop the bleeding. Because the blood increases the pressure in the brain, which can destroy the sensitive tissue. Other ways to take the pressure off the brain and reduce swelling:

• Elevate upper body
• Treatment with draining infusions
• artificial respiration / oxygen supply
• Administration of painkillers and sedatives
• Lowering the body temperature
• Laying a drain that drains away fluid

Cerebral edema (accumulation of water in the brain tissue) can occur as complications. Some patients also have epileptic seizures or pass out.

Course: chances of survival after a cerebral haemorrhage

Patients with a cerebral haemorrhage suffer relatively often complications and have to be transferred to the intensive care unit. If someone does not get to the hospital on time, there is a high risk that they will not survive the cerebral hemorrhage. Overall, after an intracerebral hemorrhage, only about 40 percent of those affected are still alive one year later. Many die while being treated in hospital. Others are limited in the long term and then have problems coping with even simple everyday activities.

After a stroke caused by cerebral hemorrhage, there is a high risk of deep vein thrombosis. In contrast, early mobilization of the person affected and wearing compression stockings help. When taking blood-thinning medication, it is crucial that you consult your doctor.

The hospital stay is usually followed by rehab with physiotherapy, speech therapy, neuropsychological and occupational therapy applications. Afterwards, those affected should continue to do the exercises they have learned at home on a regular basis. Before driving a vehicle, a specialist doctor must check its fitness to drive. Adjustments are often necessary in the home environment. Because depending on how badly the brain tissue has been affected, some skills cannot be relearned.

Cerebral haemorrhage: How to prevent it

People who suffer from high blood pressure should take their medication regularly and make check-ups with their doctor. It is particularly dangerous to take blood thinners at the same time if your blood pressure is too high. Those who drink large amounts of alcohol increase the risk of falls and thus of epidural bleeding. Smoking, diabetes and high cholesterol levels, as well as a family history of strokes, can increase the risk. Anyone who knows that they are at risk should avoid strenuous and especially sudden physical exertion.

On the other hand, a healthy diet with lots of vegetables and little animal fat and plenty of exercise in the fresh air can reduce the risk of a stroke. Nutrition specialists also recommend a low-salt diet and reducing excess weight.

Warning signs often appear before a stroke occurs. For example:

• Vertigo and balance disorders
• Brief numbness in any part of the body
• Short-term problems understanding language or expressing things
• Temporary disorientation
• Limitations of the field of vision (problems recognizing objects at the edge of the field of vision)

If such symptoms arise, people should be taken to hospital immediately. Even when such symptoms occur, which are sometimes considered harmless, every minute counts. Therefore, the detour via the family doctor should not be chosen. It is imperative that helpers express suspicion of a stroke over the phone. It has been shown that patients treated within three hours in specialized hospitals have significantly better chances of surviving or even getting well again.

If someone already shows symptoms of a cerebral haemorrhage, they should be placed in a raised upper body. Words of comfort also help. At the same time, the sick person should be transported to a hospital as quickly as possible. It is important that this has a well-staffed and technically well-equipped intensive care unit (stroke unit).

How to reduce your risk of stroke