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Brain hemorrhage

A brain hemorrhage is a condition in which blood leaks into or around the brain tissue. It is classified under different names depending on the location of the bleeding.

Brain hemorrhage refers to the leakage of blood into or around the brain tissue. It is classified by its location:

  • Intraparenchymal Hemorrhage: Bleeding within the brain tissue itself.

  • Subarachnoid Hemorrhage: Occurs on the surface of the brain, in the space containing the cerebrospinal fluid.

  • Intraventricular Hemorrhage: Leakage of blood into the fluid-filled chambers (ventricles) within the brain.

  • Subdural Hemorrhage: Bleeding that develops beneath the dura mater, the membrane surrounding the brain.

  • Epidural Hemorrhage: Occurs outside the dura mater.

A patient can present with more than one type of hemorrhage simultaneously.

Intracranial hemorrhage is a serious condition that can result in permanent disability or death if not intervened upon rapidly and accurately. Thanks to advancements in the field of interventional neurology, many vascular causes can now be managed using minimally invasive, endovascular treatment methods without the need for open surgery.

Prof. Dr. Demet Funda Baş

Causes of Intracranial Hemorrhage

The primary causes of intracranial hemorrhage are:

  • Hypertension: High blood pressure is the most common cause in adults.

  • Trauma: Particularly prevalent in younger age groups.

  • Aneurysm Rupture: Rupture of a cerebral aneurysm.

  • Arteriovenous Malformation (AVM) Rupture: Rupture of a vascular malformation.

  • Brain Tumors:

  • Coagulopathies or Anticoagulant Medication: Bleeding disorders or the use of blood-thinning medications.

Is a Brain Hemorrhage a Type of Stroke?

Yes. A stroke occurs when brain tissue is damaged due to a disruption in blood flow. This disruption can be caused by a vessel occlusion (ischemic stroke) or by bleeding (hemorrhagic stroke).

Symptoms of Intracranial Hemorrhage

Symptoms vary depending on the location, volume of the bleed, and the specific area of the brain affected.

  • Sudden loss of consciousness

  • Severe headache (often described as a “thunderclap” headache)

  • Speech disturbance (dysarthria or aphasia)

  • Unilateral weakness or sensory loss

  • Balance disorders, diplopia

  • Coma

While some minor hemorrhages may present with subtle symptoms, large-volume bleeds can be fatal.

Imaging Modalities in Intracranial Hemorrhage

  • Computed Tomography (CT): Rapidly identifies the presence, location, and size of the hemorrhage.

  • Magnetic Resonance Imaging (MRI): Provides additional information regarding the underlying cause of the bleed.

  • Cerebral Angiography: Most accurately reveals vascular causes such as aneurysms or arteriovenous malformations (AVMs).

Treatment Strategy

Treatment is planned based on the cause, location, and size of the hemorrhage, as well as the patient’s clinical status.

  • Medical Management: For small hemorrhages, management involves blood pressure control, intensive care monitoring, and follow-up imaging.

  • Surgical Intervention: May be performed to evacuate large hematomas or to relieve life-threatening mass effect.

  • Interventional Neurological Procedures: Vascular causes like aneurysms or AVMs can be repaired using endovascular techniques.

Recovery and Rehabilitation

The recovery process following an intracranial hemorrhage varies for each individual. The first 6 months typically represent the period of most rapid improvement, with progress slowing thereafter. Rehabilitation, which should be conducted via a multidisciplinary approach, aims to maximize the patient’s remaining neurological function.