Brain Hemorrhage

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Brain hemorrhage meaning | What is a brain hemorrhage?

 

A brain hemorrhage is bleeding in or around the brain.

 

Brain hemorrhage is a commonly used term to describe all bleeding related to the brain, but in actual practice, there are different types of brain hemorrhage.

 

All bleeds inside the skull are called intra-cranial hemorrhages. And so when someone talks about a brain hemorrhage, they’re talking about an intra-cranial hemorrhage.

 

Bleeds that occur outside the skull, are usually not as dangerous. These are scalp bleeds (also known as sub-galeal hematomas). When someone talks about a brain hemorrhage though, they are generally referring to a bleed within the contents of the skull (an intra-cranial hemorrhage).

 

 

Types of brain hemorrhage | What are the types of brain hemorrhage?

 

The types of brain hemorrhage are based on the location of the bleed. A patient might have one or more types of brain hemorrhage at the same time.

 

The types of brain hemorrhage are:

 

1) Intra-cerebral or intra parenchymal hemorrhages:

Those bleeds that happen within the substance of the brain are called intra-cerebral or intra-parenchymal hemorrhages.

 

2) Sub-arachnoid hemorrhages:

Those bleeds that occur in the tiny spaces between the brain and the thin tissue that covers the brain are called sub-arachnoid hemorrhages.

 

3) Intra-ventricular hemorrhages:

There are bleeds that occur within the spaces that act as containers for the nutritive fluid of the brain (this fluid is called Cerebrospinal fluid and the large containers of this fluid are called ventricles). Such bleeds are called intra-ventricular hemorrhages.

 

4) Sub-dural hemorrhages:

The brain is covered by a thick protective sheet called the dura. Bleeds that occur between the dura and the surface of the brain are called sub-dural hemorrhages.

 

5) Extra-dural hemorrhages:

These are bleeds that occur between the thick protective layer of the brain called the dura and the overlying skull. That’s why they are called extra-dural. The blood is not in direct contact with the brain surface, but instead lies between the skull bones and the protective dural layer.

 

 

 

 

 

 

 

 

Brain hemorrhage reason | Causes of brain hemorrhage | What are the causes of brain hemorrhage?

 

There are many causes of brain hemorrhage. Every type of brain hemorrhage has its own unique causes. Here we’ll mention the most common causes of brain hemorrhage.

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        Bleeding from brain vessels due to high blood pressure:

This is one of the most common causes of brain hemorrhage. This type of bleed most commonly causes intra-cerebral (intra-parenchymal) and intra-ventricular bleeds.

 

        Bleeding from head injury / head trauma / accidents:

This is also one of the most common causes of brain hemorrhage. Head injury most commonly causes sub-dural and extra-dural bleeds. But can also cause the other types brain hemorrhage.

 

        Bleeding from abnormal blood vessels of the brain:

This type of bleeding occurs because of some problem with the structures of the blood vessels supplying blood to the brain. This includes diseases like brain aneurysms and brain vascular malformations (avm, cavernoma etc). These types of diseases most commonly cause sub-arachnoid hemorrhages, but can cause any of the other types of hemorrhage.

 

        Bleeding from space occupying diseases of the brain like brain tumors:

This type of bleeding occurs due to to diseases of the brain that destroy the brain structure like brain tumors and infections of the brain.

 

        Bleeding due to medicines taken by the patient:

There are many patients, specially older ones who are on medications that decrease the capacity of their blood to clot. This means that if there is damage to their blood vessels and their blood spills out, it wont stop spilling. These are medications like Aspirin and Clopidogrel that affect the platelets of the blood or medicines like warfarin and heparin that affect the clotting factors in the blood. People take these medicines for a number of reasons, the most common being heart diease of the presence of stents in the heart, which needs them to take these medicines commonly called ‘blood thinners’. In such patients, even a small damage to the blood vessels of the brain, whether due to raised blood pressure or injury, can cause massive bleeding within the brain.

 

       Brain hemorrhage after surgery:

Surgical procedures on the brain are always a risk factor for brain hemorrhage. Brain hemorrhage may also result from surgical procedures on other parts of the body, specially those in which the ability of the blood to clot is compromised, such as thrombolysis and if there is massive blood loss in a surgery.

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Brain hemorrhage symptoms | What are the symptoms of brain hemorrhage?

 

The most common symptoms of brain hemorrhage are:

 

1. Headache, usually sudden and severe and commonly not resolving on usual medications.

2. Vomiting.

3. Weakness or paralysis of the hands and legs.

4. Tingling and numbness in the body.

5. Disfiguration of the face, particularly noticed as a drooping of the angle of the mouth, i.e. a disfigured smile or jaw line.

6. Slurring of speech.

7. Altered senses, i.e. talking non-sensically, not being able to recognise people, not being able to recognise the place or the time of the day and not understanding peoples instructions or questions.

8. Seizures, which are abnormal movements of the hands and leg, often associated with unconsciousness.

9. Blurring of vision.

10. Drowsiness, sleepiness and lethargy.

11. Unconsiousness.

12. Coma.

13. Brain hemorrhages can rapidly lead to death.

 

 

 

 

 

 

 

Brain hemorrhage diagnosis | How is brain hemorrhage diagnosed?

 

The doctor can suspect that someone may be having a brain hemorrhage on the basis of their clinical examination, but confirmation is usually done with the help of radiological tests/scans of the head.

 

Clinical Examination in Brain hemorrhage:

On clinical examination, the doctor will ask the patient and/or the attendants about all the circumstances of the patient’s problem. The time of the initial complaint, which is usually sudden, severe headache, is very essential. The sooner a patient presents to the doctor in the emergency after the first symptom, the better his or her chances of recovering are. The doctor will ask questions like:

 

1. When did the headache start?

2. Was there any vomiting?

3. Were there any seizures?

4. Is there any weakness or paralysis?

5. Has the weakness gotten worse?

6. Since when has the patient been unconscious?

7. When did the patient start speaking non-sensical or irrelevant things?

8. Is the patient suffering from high blood pressure or diabetes?

9. Were they on regular medication and did they get regular checkups?

10. Have they skipped any recent medication?

11. Is the patient on any medicine like an anticoagulant or anti-platelet (blood thinner)?

 

After this line of questioning, the doctor will examine the patient for signs that there has been a brain hemorrhage, including checking the patient’s pulse and blood pressure, any weakness or paralysis in the body, any slurring of speech and any deficits in understanding or in speaking. There are many signs of brain hemorrhage that can be found even in an unconscious patient, including unequal pupils, which is considered a reason for urgent imaging/scanning.

 

The doctor will then refer the patient for an imaging scan of the head. This is often done urgently and simultaneously with the examination of the patient, specially if the patient is unconscious and there are clear signs of a problem with the brain.

 

Scans used in brain hemorrhage:

1. CT: A Computed Tomography scan (CT scan or CAT scan) is the most commonly done scan to detect a brain hemorrhage. It has a very high detection rate, and is a rapid test.

2. MRI : In selected cases, the doctor might ask for an MRI scan (magnetic resonance imaging).

3. Angiography: In some cases, the doctor might need to find the sight of the bleed and for this they might order an angiography of the brain which is a study of the blood vessels of the brain. Angiography is of different types, and includes CT angiography, MRI angiography. But the gold standard for angiographic testing is the Digital Subraction Angiography which is done by placing a catheter in the large vessels of the brain and used a dye to study the blood vessels of the brain.

 

 

 

 

 

 

 

 

Brain hemorrhage treatment | What is the treatment of brain hemorrhage?

 

The treatment of brain hemorrhage depends on the type of hemorrhage, the severity of the bleed, the condition of the patient and the underlying cause of the hemorrhage. Treatment includes both surgical and medical methods.

 

It is very important to note that once a brain hemorrhage has occurred, the measures of treatment are directed at preventing only the cause of re-bleeding, increase in size of the clot and swelling of the brain due to the insult of the brain tissues by the bleed. There exist no evidence based confirmed measures to help the damage already caused by the bleed. What this means is, that if a patient has one side paralysed by the bleed, then removing the bleed might save the patient’s life, but it might not improve the paralysis, which may heal to some extent over time and with the help of physiotherapy.

 

Brain hemorrhage medical treatment | What is medicine for brain hemorrhage?

 

Medical treatment of brain hemorrhage includes measures such as:

 

1)Strict control of blood pressure to prevent re-bleeding or increase in size of the bleed including anti-blood pressure medicines by mouth or by injection.

2)Medicines to reduce the swelling of the brain like Mannitol.

3)Medicines to reduce the pressure in the brain by decreasing the production of brain fluid (CSF/Cerebrospinal fluid) particularly in intra-ventricular types of bleed.

4)Medicines to reverse any blood coagulation derangements and any medicines that prevent coagulation of blood, including transfusion of blood components such as Fresh Frozen Plasma (FFP) and Platelet Transfusions (RDP/SDP).

5) The patient often needs to be placed on ventilator support to maintain oxygenation and sedation to keep the body at rest, which is also a measure to reduce the pressure in the brain.

6)Anti-seizure medication.

 

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Brain hemorrhage surgery | What is surgery for brain hemorrhage?

 

Surgery for brain hemorrhage is performed with two considerations in mind:

 

1. To reduce the pressure in the brain.

2. To treat any underlying cause of the hemorrhage.

 

1. Reduction of pressure in the brain: If medical measures fail or if the clinical condition fo the patient warrants emergency reduction in the pressure of the brain, a Neurosurgeon might need to perform pressure relieving surgery on the brain. These measures are clearly only for life saving purposes. These include procedures such as –

• Craniotomy and evacuation of a brain hemorrhage (Making an opening in the skull and removing the hemorrhage clot).

• Decompressive craniectomy – Removing a portion of the skull to allow the brain to expand outwards. The bone removed may be preserved in a special deep freeze or in a surgical pocket made in the abdomen or the thigh.

• Ventricular Drainage – Specially done in cases of Intra-ventricular bleeds and bleeds that lead to an increase in the brain fluid (CSF) containing reservoirs in the brain called ventricles. Making a hole in the skull and placing a pipe into the ventricles helps to drain these blocked spaces and reduces pressure in the brain rapidly. These drainage procedures may be External Ventricular Drainage into a bag outside the body or a VP shunt procedure in which an internal pipe is placed to drain the fluid within the body itself.

 

   2. Treating the cause of the bleed: These surgeries treat any underlying cause for the bleed that may be surgically treatable. Examples of these procedures include-

 

• Craniotomy and clipping of a brain aneursym

• Intra-vascular Coiling for a brain aneurysm

• Craniotomy and excision of a bleeding Arterio-venous malformation (AVM)

• Intra-vascular embolisation of an AVM that is not surgically treatable.

• Craniotomy and excision of a brain tumor.

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Brain hemorrhage survival rate | What is the survival rate for brain hemorrhage?

 

Many people try to look for an absolute survival rate for brain hemorrhage. Websites often provide a death rate of  30 to 50 %. What readers need to understand is that the survival rate depends strongly on the type of brain hemorrhage, the cause for the hemorrhage, the condition of the patient at presentation to the hospital and the presence of other patient factors such as age, heart disease, diabetes or any other long term diseases.

 

It is essential to know that brain hemorrhage is a life threatening disease. Survival rates are poor without treatment. More importantly, patients who survive might be in a coma for many years, maybe even the rest of their lives. Surviving patients might have paralysis and other deficits due to the brain hemorrhage, that might improve completely, partially or not at all.

 

Brain hemorrhage Aryuvedic treatment and Alternative medicine

 

In the recovery and rehabilitation phase of brain hemorrhage, many of my patients ask me about the benefits of Ayurveda and other forms of Alternative medicine like Homeopathy and Unani.

 

Unfortunately, Allopathic medicine still has no sure-fire treatment for the deficits caused due to brain hemorrhage like coma, paralyis and speech defects. That is the reason why many patients want to give Brain hemorrhage treatment by Ayurveda and Alternative medicine a try.

 

My advice on this is that I do not know of any sure-fire 100% therapies for the same problem in any of these other forms of treatment either. No one can guarantee improvement. All forms of medicine can only try.

 

Physiotherapy, Speech therapy, Occupational therapy, mental stimulation by conversations, music and video stimulation like making the patient watch movies or television serials are all recommended by allopathic physicians and neurosurgeons. They help in improving the chance of recovery.

 

Many alternative forms of medicine claim to have good results in the improvement of consciousness and paralysis after brain hemorrhage. It is not wrong to try to seek answers in other forms of medicine for problems that allopathy has only a limited treatment for. But, a warning about the same is important. If you are considering Ayurveda or other treatments, it is important to note that oral medicines given by Ayurvedic and alternative practitioners might interfere with the medicines given by allopathic doctors which might be harmful. No allopathic doctor will comment on the medicines given by any other type of practitioner and vice-versa. The risk of medical interaction between the two types of medicines in the body and the chances of a side-effect resulting from this is always with the patient and their attendants.

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