Cerebral hemorrhage

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What is it about ?

A cerebral hemorrhage is bleeding in the brain and can be considered a form of stroke. Stroke is a disease that affects the bloodstream in part of the brain. Part of the brain therefore no longer receives oxygen for a longer or shorter time. This causes sudden loss of certain functions of the body.

Stroke is a collective term for different problems that occur in the brain:

  • cerebral infarction : A blood clot is blocking a blood vessel in the brain.
  • cerebral hemorrhage: a blood vessel in the brain bursts.

The main cause of brain hemorrhage isarterial hypertension, which causes damage to the walls of small blood vessels. Other possible causes are excessive alcohol consumption, birth defects of the blood vessels, brain tumors and anticoagulant therapy.

What is its frequency?

Due to better treatment for high blood pressure, brain hemorrhages have become less frequent. About 15% of strokes are brain hemorrhages.

How to recognize it?

Symptoms can vary depending on where the bleeding is in the brain. The most common sign is the sudden onset of paralysis of half the body (hemiplegia). This is also the case with other types of stroke, but since the bleeding does not stop immediately, the symptoms increase quickly. In 50% of cases, the bleeding continues for 24 hours. This can be accompanied by decreased consciousness or even complete unconsciousness, vomiting, and sometimes an epileptic fit with convulsions.

Besides vomiting, bleeding in the cerebellum causes dizziness, uncoordinated movements and disturbed eye movements. Sometimes you can see that the eyes are moving with little bumps. In the event of heavy or massive bleeding, coma and respiratory arrest may occur.

How is the diagnosis made?

A person presenting symptoms of paralysis and reduced consciousness is admitted urgently to the hospital, if possible to a specialized service, the “stroke unit”. It is the unit that welcomes people who have a stroke. A CT scan of the brain is always performed as soon as possible. Most often, the diagnosis is obvious. Sometimes an additional MRI is necessary.

What can you do ?

Call emergency services immediately if a person has symptoms of paralysis or a change in consciousness. If you are completely unconscious, check your heart rate and breathing. Apply resuscitation techniques if necessary.

What can the doctor do?

Treatment always begins in the hospital and has two components: stopping the bleeding and revalidating the symptoms of paralysis.

The first thing to do to stop the bleeding is to regulate the blood pressure. Blood pressure should not drop too quickly or too low. The target is blood pressure below 180/100 mmHg. Blood coagulation is immediately checked and, if necessary, adjusted with clotting factor concentrates. Surgery to reduce the amount of blood in the brain is rarely necessary. It all depends on where the bleeding is and how much.

The revalidation start as soon as possible, preferably on the second day of treatment. The approach is always multidisciplinary, the physiotherapist, speech therapist, occupational therapist, the nursing team and of course the family working closely together.

Want to know more?

http://belgianstrokecouncil.be/fr/

Source

Foreign clinical practice guide ‘Intracerebral hemorrhage’ (2000), updated on 08/28/2017 and adapted to the Belgian context on 05/23/2019 – ebpracticenet

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