Cerebral hemorrhage: symptoms, what causes?

A cerebral hemorrhage is severe. It involves the vital prognosis and therefore must be quickly detected and support.

Cerebral hemorrhage results in rupture of a blood vessel in the brain – it is a hemorrhagic cerebrovascular accident (CVA) – causing a bleeding in the skull. Cerebral hemorrhage is 20% of strokes. Its severity depends on its location in the brain, and the extent of the brain areas affected.

“The clinical signs of a cerebral hemorrhage are usually a neurological deficit that worsens over minutes or hours, with many variations depending on the exact location and extent of the haemorrhage; convulsions are possible; intracranial hypertension as well” describes Dr. Bruno Toussaint. To minimize the risk of sequelae, even death, it is essential to recognize the signs of a stroke (whether hemorrhagic or ischemic) because at this stage it is impossible to differentiate them, and to call for help as quickly as possible. THE following warning symptoms must lead to call 15:

• facial numbness, with an impossibility of smiling, or a deformation or paralysis of the face, with for example the lip drooping on one side.
• loss of strength or numbness of an upper limb: inability to lift arm. numbness or weakness in one leg. A speech disorder: difficulty speaking or repeating a sentence.
• a difficulty understanding the other person.
• a sudden loss of balance: unsteadiness when walking.
• A intense, sudden and unusual headache.
• A vision problemeven temporary: loss of sight in one eye or double vision.

These are the most common symptoms, but there are others. Cerebral hemorrhage can indeed manifest itself differently, depending on the region of the brain that is suffering.

There main cause of bleeding brain is a high blood pressure (arterial hypertension or hypertension). In some cases, and “in young patients, rupture of a blood vessel may occur on a pre-existing abnormality of the artery, most often present from birth: an aneurysm or arteriovenous malformation“. While, “In elderly patients, these hemorrhages are most often secondary to lesions of the small arteries, favored by arterial hypertension. They are also more frequent in the event ofalcoholism, and can be caused or favored by treatments, especially anticoagulants, antiaggregants or thrombolytics. Another cause is the head traumawhich can cause bleeding in the brain “says Dr. Bruno Toussaint. risk factors for cerebral hemorrhage are :

• Age: the risk of stroke increases with age, after 50 years in men and after 60 years in women.
• Family history of stroke or cardiovascular disease.
• Poorly controlled diabetes, with excess glucose in the blood, can damage the walls of the arteries and is a risk factor.
• Alcohol consumption, whatever its level, increases the risk of hemorrhagic stroke, as does tobacco.
• Atrial fibrillation (the atria in the heart beat very fast) is a heart rhythm disorder that can be treated.
• A high cholesterol level.
• Obesity and overweight.
• Sedentary lifestyle and lack of physical activity.

A brain imaging test by MRI and scanner, must be put in place in the first hours following the “brain attack”.

In case of cerebral hemorrhage,there management of the immediate consequencesFor example in intensive care in case of coma, and the cause (arterial hypertension, excess anticoagulant, etc.) is crucial”. If the cerebral hemorrhage occurred in a patient taking anticoagulant therapy or with blood coagulation disorders, a specific treatment is put in place to quickly correct these abnormalities.

“At one year, there are only 50% of survivors”

Finally, “in certain situations of haemorrhage by trauma, a drug acting on coagulation (tranexamic acid) slightly reduces short-term mortality due to trauma“. However, to date, there is no specific treatment to limit the expansion of the hemorrhage. The rest of the treatments will be depending on the sequelae:physiotherapy, rehabilitationdepending on the deficit”, notes the expert. Different health professionals can be mobilized for follow-up after the person has returned home: the attending physician, a nurse, a massage therapist, a speech therapist and specialist doctors (neurologist, geriatrician or physical medicine and rehabilitation doctor) .

An operation is sometimes considered when“it seems possible to surgically evacuate the hematoma” by radio-guided microsurgery, specifies the doctor, and in the case where the artery is accessible and repairable.

The prognosis results from several factors: “It largely depends on the patient’s age, the volume and location of the hematoma, the neurological evolution in the first hours of the hemorrhage, or even the cause of the hemorrhage.“. The sequelae are motor and cognitive : oral and written language disorders, affecting expression and understanding, impaired arm and hand motor skills, and in some cases, difficulty walking. Sometimes, “even in patients who apparently have no sequelae, there persists a disability often described as invisible: fatigue, concentration disorder, anxiety, irritability“, describe vascular neurologists and researchers within the “Inserm Degenerative and Vascular Cognitive Disorders” unit at the Lille University Hospital.

“Hemorrhagic accidents are more serious than cerebral infarctions. One year after a cerebral hemorrhage, there are only 50% of survivors and half of them have a significant disability. Only a quarter do well and can retain their independence.”note the neurologists of Inserm.

Thanks to Dr. Bruno Toussaint, doctor and director of the journal Prescrire.