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We can examine intracranial hemorrhages in two parts as trauma-related and non-traumatic.

 

BRAIN BLEEDINGS THAT ARE NOT RELATED TO TRAUMA

 

It is sudden bleeding that develops as a result of damage to the brain vessels due to various reasons without trauma in the brain tissue and occurs in different parts of the brain tissue.

Key information

  • It accounts for 15-30% of strokes, but is the most deadly.

  • The difference due to ischemia is that it develops slowly from minutes to hours, often severe headache, vomiting and changes in the level of consciousness.

  • Non-contrast computed tomography (CT) is initially preferred in the diagnostic study

  • Amount of blood  correlates with risk of symptoms and death

  • The clot enlarges within the first 3 hours in at least 33% of cases

  • Angiography is recommended in young patients, those with no previous history of hypertension or stroke, unless it precludes immediate treatment.

 

Risk factors

  • Age: Its incidence increases markedly after the age of 55 and doubles every 10 years until the age of 80. At the age of 80, the frequency is 25 times higher than in the previous decade.

  • Gender: It is much more common in men.

  • Race: In the US, it affects blacks more than whites. This may be related to the higher prevalence of hypertension in blacks than in whites. The frequency may be higher in easterners.

  • Previous SVA (stroke) (all types) increases the risk by 23:1.

  • Alcohol intake.

  • Smoking: It is among the risk factors because it disrupts the vascular structure.

  • Hypertension: This is the most important reason for the formation of the disease. Uncontrolled hypertension is a particularly high risk.

  • Diabetes: Uncontrolled diabetes increases the risk of bleeding by disrupting the vascular structure.

  • Drugs used: the use of blood thinners given for some diseases, the use of illegal and illegal drugs can cause changes in the vascular structure and lead to this disease.

  • Migraine: during or following a migraine attack (possibly a very, very rare event)

  • After arteriovenous malformation surgery: “breaking the normal perfusion pressure”. In some cases, it may be due to incomplete AVM resection.

  • Physical factors: Excessive physical load, exposure to cold…

  • Due to vascular anomalies (Arteriovenous malformation rupture or aneurysm bleeding. Rarely, venous angioma bleeding)

  • Arteriopathies: Amyloid angiopathy, cerebral arteritis, fibrinoid necrosis etc.

  • Rarely, it may be due to a brain tumor.

  • Coagulation or coagulation disorders.

  • Those receiving anticoagulant and thrombolytic therapy.

 

Symptoms

It is the rupture of a blood vessel in the brain that causes this disease. This bleeding can last from a few minutes to an hour. Sometimes it can take up to several days in the form of leakage.

Depending on the duration and severity of bleeding; sudden onset of headache, fainting, seizure, nausea, vomiting, unconsciousness. These complaints occur suddenly. However, the severity may vary according to the patient and the location of the bleeding in the brain. Edema around the hemorrhage and ischemic necrosis may cause delayed worsening. Although necrosis from the mass effect of the clot contributes little to the edema, experimental studies show that the mass effect itself cannot be entirely responsible for the extensive edema that occurs.

 

Diagnosis

  • CT examination: CT is rapid, and can easily show blood in the brain immediately after bleeding. Clot volume is important. Volume can be measured on CT, with little change in volume in the first 2 weeks.

  • MRI: Usually not needed initially.  Does not show blood well in the first few hours. It is difficult to provide respiration in an unconscious patient during the shooting. It is slower and more expensive than BT. But it might be useful later on.

 

  • Cerebral Angiography: Can show AVMs and aneurysms when associated with bleeding. The gain may increase if the run is delayed. Vascular staining may be demonstrated in some tumor cases.

 

Treatment

There is no uniform consensus on the treatment of intracerebral hemorrhages. Patients with bleeding that do not require surgery are frequently followed up by neurology clinics. If the bleeding is large in size and compresses the brain tissue, the bleeding can be drained with surgical treatment. Draining the bleeding may reduce the symptoms that may occur due to re-bleeding, edema or necrosis due to the mass effect of the hematoma (especially if aneurysm or AVM is detected as the cause), but rarely causes neurological deterioration.

 

In patients in whom the blood occludes the third chamber outlet by spreading to the chambers with CSF circulation, the blood can be drained by placing a catheter in the chambers. Patients with a significant amount of blood in the chambers end up badly. It may be difficult to maintain the drainage continuity of the catheter because of the clot.

 

Conclusion

Since this disease has a severe course, it should be known that the patient's life-threatening risk is high. In patients who survived the danger, speech disorders, seizures, and mild to severe paralysis may develop.

 

The main cause of death is compression of the brain stem, usually seen within the first week. In-hospital mortality is common for patients aged ≥65 years. Reported death rates vary widely, and depend on the size and location of the clot, the age and medical condition of the patient, and the etiology of the bleeding. The 30-day mortality rate for all hemorrhagic patients is 44%.

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