Preliminary symptoms of cerebral hemorrhage

Written by Zhang Hui
Neurology
Updated on November 25, 2024
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Cerebral hemorrhage is a severe and sudden onset condition that usually starts without any prodromal symptoms, manifesting as hemiplegia, severe headaches, or even coma. However, some patients may exhibit certain early symptoms, which mainly include: First, headache, which is not particularly severe, is tolerable, but typically affects the forehead and both temporal areas. Second, patients generally have very high, hard-to-control blood pressure. If the blood pressure is extremely high and difficult to manage, the possibility of cerebral hemorrhage should be considered. Third, in the early stages of cerebral hemorrhage, patients may experience symptoms such as dizziness, blurred vision, and general weakness. Overall, the early symptoms of cerebral hemorrhage are not particularly typical. If a patient with high blood pressure becomes hard to manage, experiences slight headaches, dizziness, blurred vision, and some nausea, these may be indicative of the early symptoms of cerebral hemorrhage.

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Causes of cerebral hemorrhage

The most common cause of cerebral hemorrhage is hypertensive cerebral hemorrhage. Patients with hypertension who do not adequately control their blood pressure, which frequently fluctuates, can lead to hardening of the cerebral vessels. The elasticity of the cerebral vessel walls diminishes, and when the blood pressure rises sharply, it can cause the cerebral vessels to rupture, leading to cerebral hemorrhage. This is the most common cause of cerebral hemorrhage, accounting for over 80%. Another common cause of cerebral hemorrhage is the rupture of cerebral aneurysms, which often leads to subarachnoid hemorrhage. Patients with this condition experience severe headaches, consciousness disturbances, and restlessness. Subarachnoid hemorrhage is a relatively severe medical condition with a high mortality rate. Additionally, some cerebral hemorrhages are caused by trauma, leading to cerebral contusion, skull fractures, subdural hematoma, and epidural hematoma. These causes account for a relatively small proportion of clinical cases.

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Is cerebral hemorrhage serious?

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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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.

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Principles of Treatment for Cerebral Hemorrhage

For patients with cerebral hemorrhage, the main principle of treatment is to control the blood pressure in a relatively stable state. Blood pressure should not be too high or too low. If it is too low, it can easily lead to insufficient cerebral perfusion pressure, thus causing local cerebral tissue ischemia and hypoxia, leading to the occurrence of cerebral infarction. If the blood pressure is too high, it can easily exceed the regulatory function of the blood vessels, often causing secondary hemorrhage. Secondly, it is important to promptly monitor the patient's vital signs, observe the patient's consciousness, pupils, and limb movement, and timely perform a follow-up head CT scan to dynamically observe the changes in the patient's condition.

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Does cerebral hemorrhage have a genetic basis?

Cerebral hemorrhage is not hereditary and is not a genetic disease; it is a type of acute cerebrovascular disease. Its occurrence is related to risk factors of cerebrovascular disease, and some risk factors may be related to genetics. Therefore, having a family history of cerebral hemorrhage is considered one of the factors that can increase the incidence rate of cerebral hemorrhage in patients. For example, if a patient's parents have hypertension, diabetes, or hyperlipidemia, these risk factors can significantly increase the likelihood that the patient will also develop these conditions as they age. Long-term hypertension, diabetes, and hyperlipidemia can lead to arterial wall hardening, sometimes resulting in hyaline degeneration. When blood pressure fluctuates, it can easily form microaneurysms that rupture and bleed, thus causing cerebral hemorrhage. Therefore, although cerebral hemorrhage itself is not hereditary, hereditary-related conditions such as hypertension and diabetes might lead to its occurrence.