Is cerebral hemorrhage serious?

Written by Gao Yi Shen
Neurosurgery
Updated on September 25, 2024
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The critical period for cerebral hemorrhage is generally around 14 days, as it primarily involves overcoming two most dangerous phases. The first phase is within three days of the cerebral hemorrhage. This period is most feared for the potential increase in bleeding. Often, if blood pressure is not well controlled, it can easily lead to further bleeding, especially within the first three days which has the highest incidence. The second phase is approximately 10-14 days after the cerebral hemorrhage, because this period marks the peak of cerebral swelling and cerebral vasospasm. The main concern here is severe cerebral swelling and cerebral vasospasm, which can lead to cerebral infarction, and potentially extensive cerebral infarction, possibly resulting in death. Trepanation surgery may be necessary to save the patient.

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Complications of Cerebral Hemorrhage

The main complications of cerebral hemorrhage are infections or fever, especially aspiration pneumonia, which is quite common. The second complication is hyperglycemia. The third is stress ulcers and gastrointestinal bleeding. The fourth complication involves cardiac issues, as patients with cerebral hemorrhage are prone to neurogenic cardiac damage. Another complication is epilepsy; patients with lobar hemorrhage are likely to experience recurrent seizures. Additionally, there is also central fever.

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Early warning signs of cerebral hemorrhage

Cerebral hemorrhage is an emergency in neurology, typically presenting acutely with little to no warning signs. Patients usually experience rapid onset of symptoms including headache, nausea, vomiting, and paralysis of limbs. A detailed look at the patient's medical history may reveal some prodromal symptoms such as recent overexertion, emotional excitement, lack of rest, or constipation, which are common triggers. If a patient experiences repeated chronic headaches and general weakness, these could be the mechanical prodromal symptoms of cerebral hemorrhage. A significant fluctuation in blood pressure should also raise concerns about the possibility of a cerebral hemorrhage. Once a cerebral hemorrhage occurs, it is crucial to promptly seek hospital treatment. If the volume of the hemorrhage is substantial, it poses a life-threatening risk to the patient and surgical treatment may be necessary. If the hemorrhage is smaller, conservative treatment may suffice, focusing on bed rest, maintaining emotional stability, and administering neuroprotective medications.

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What are the symptoms of cerebral hemorrhage?

Patients with cerebral hemorrhage typically experience sudden headaches during physical activity or emotional excitation as their initial symptom, which may be accompanied by nausea and vomiting. In severe cases, vomiting can be projectile, consisting of stomach contents. If the patient has stress ulcers leading to bleeding and erosion of the gastric mucosa, they may vomit a coffee-ground-like liquid, which is a mixture of gastric juices and blood. Additionally, patients may also exhibit disturbances in consciousness, such as drowsiness, stupor, or even coma. If the patient is conscious, one may observe hemiplegia or paralysis, sometimes accompanied by speech impairments or psychiatric symptoms. Some patients may also experience epileptic seizures.

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What should be done about cerebral hemorrhage?

Cerebral hemorrhage is a relatively serious disease. After a cerebral hemorrhage occurs, patients usually experience noticeable headaches, nausea, and vomiting. The onset is relatively rapid, and it may present clinical symptoms such as slurred speech, deviation of the mouth, and paralysis of one side of the body. In severe cases, the patient may become comatose or even die. Once diagnosed with cerebral hemorrhage, it is necessary to immediately rush to the nearest hospital for treatment. It is important to ensure the patient rests in bed, keeps their emotions stable, avoids emotional excitement, and maintains regular bowel movements without straining. If cerebral hemorrhage causes increased intracranial pressure, dehydration medications to reduce intracranial pressure can be used. Additionally, medications to protect brain cells should be used. It is crucial to actively control the patient's blood pressure and, when the condition stabilizes, to perform regular rehabilitative exercises to promote the recovery of neurological functions. If the volume of the cerebral hemorrhage is large and threatens the patient's life, neurosurgery may be needed to save the patient's life.

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How is cerebral hemorrhage treated?

The treatment for brain hydrocephalus includes conservative medical treatment and surgical intervention. Conservative medical treatment is primarily for patients with a lesser amount of bleeding, using methods such as hemostasis, brain protection, dehydration to reduce intracranial pressure, and maintaining electrolyte balance for symptomatic support treatment. For bedridden patients, it's also necessary to prevent and treat various complications such as pulmonary infections, urinary system infections, and venous thrombosis. Surgical treatment is mainly for patients with a larger volume of bleeding, approximately 30mL of cerebrospinal fluid bleeding, cerebellar bleeding over 10mL, or cerebellar bleeding less than 10mL but causing brainstem compression. Patients with hydrocephalus should actively consider surgery to remove the hematoma. The decision to perform decompressive craniectomy is based on preoperative and intraoperative findings. In some cases, where the brain compression is not severe, or in elderly patients who have poor tolerance for surgery, minimally invasive surgery to remove the hematoma may be considered.