Brain Hemorrhage

Brain hemorrhage refers to a serious condition caused by the rupture or leakage of blood vessels within the brain tissue. This condition arises due to the leakage or spread of blood into the brain tissue and can lead to severe neurological problems. Generally, all types of bleeding occurring within the brain, between the membranes of the brain, or between the skull and the scalp are collectively referred to as brain hemorrhages. Brain hemorrhage is a serious health issue that requires immediate intervention and can cause functional losses and fatalities in the body.

Causes of Brain Hemorrhage

Brain hemorrhage can commonly occur due to two reasons: spontaneous and traumatic causes. It is most frequently observed in cases of trauma. Brain hemorrhage is commonly seen following traumas such as traffic accidents or falls. Spontaneous hemorrhages are those that occur naturally in a part of the brain. For example, spontaneous hemorrhage may occur after the rupture of an aneurysm in the brain vessels.

Other causes include:

• Hypertension (High Blood Pressure): Hypertension is one of the most common causes of brain hemorrhage. High blood pressure can weaken arterial walls, leading to hemorrhage.
• Angiopathy and Aneurysms: Angiopathy refers to the abnormal structure of blood vessels. Aneurysms are weak spots in the walls of blood vessels that can rupture over time.
• Thrombolytic Treatments: In some cases, medications used to thin the blood can reduce the blood’s ability to clot, leading to hemorrhage.
• Injuries: Head trauma or brain surgeries can damage blood vessels, increasing the risk of hemorrhage.
• Medications: Some medications used to prevent blood clots can cause brain hemorrhage if used in excessive doses.

Risk Factors

• Age: Advanced age increases the risk of brain hemorrhage.
• Gender: The risk of brain hemorrhage is slightly higher in men than in women.
• Family History: Individuals with a family history of brain hemorrhage may have an increased risk.
• Smoking and Alcohol Use: Smoking and excessive alcohol consumption can increase the risk of brain hemorrhage.
• Hypertension: Uncontrolled high blood pressure increases the risk of brain hemorrhage.
• Diabetes: Diabetes can also increase the risk of brain hemorrhage.
• Obesity: Can put extra stress on blood vessels and increase blood pressure.

Symptoms of Brain Hemorrhage

Brain hemorrhage occurs when there is bleeding within or around the brain. Symptoms of brain hemorrhage may include:

• Sudden Headache: A severe and sudden headache is an important symptom of brain hemorrhage.
• Loss of Consciousness or Drowsiness: Brain hemorrhage can often lead to loss of consciousness or stupor. This state of unconsciousness typically develops suddenly.
• Neurological Symptoms: Neurological symptoms such as weakness on one side or both sides of the body, paralysis, loss of balance, facial asymmetry, or speech disturbances may appear.
• Nausea and Vomiting: Sudden severe headache is often accompanied by nausea and vomiting.
• Vision Disorders: Sudden vision loss, double vision, or disturbances in eye movements may also be symptoms of brain hemorrhage.
• Changes in Consciousness: Symptoms such as restlessness, clouding of consciousness, agitation, or excessive drowsiness may be observed.
• Coordination Problems: Sudden balance issues or difficulty walking may be signs of brain hemorrhage.

Diagnostic Methods

The most valuable examination for brain hemorrhage is Brain Computed Tomography (CT). Brain CT is the best and fastest way to show hemorrhage. It can determine whether symptoms and findings detected during the examination are due to hemorrhage and identify the type of hemorrhage if present. Additional tests such as Computed Tomography Angiography, MRI, and MR Angiography can help identify the underlying cause. Digital Subtraction Angiography (DSA) is the most advanced brain hemorrhage examination method, allowing visualization of brain vessel pathologies similar to a heart angiogram.

Treatment of Brain Hemorrhage

When diagnosed with brain hemorrhage, patient stabilization and, if necessary, intensive care support may be required. Reducing blood pressure or other emergency interventions may be needed depending on the severity and cause of the hemorrhage.

• Surgical Intervention: Surgical intervention may be required for some brain hemorrhages. Especially for large, life-threatening hemorrhages, surgical methods can be used to identify the source of the hemorrhage and stop it. Procedures such as craniotomy or embolization may be used for this purpose. In some cases, a hole may be drilled into the skull to drain the blood.
• Medication Treatments: Medications play an important role in the treatment of brain hemorrhage. Drugs that reverse the effects of blood thinners or reduce the risk of hemorrhage can be used. Additionally, medications to lower blood pressure are crucial in managing brain hemorrhage.
• Rehabilitation: Post-brain hemorrhage rehabilitation helps patients regain functions. Physiotherapy, speech therapy, nutritional support, and psychological support are important in improving patients’ quality of life.

Brain hemorrhage is a serious condition, and the treatment approach may vary for each patient. The treatment plan is determined based on the type, location, and general health status of the patient. Early diagnosis and effective treatment can increase the chances of recovery and reduce the risk of complications.

Types of Brain Hemorrhage

• Parenchymal Hemorrhages: These types of hemorrhages occur within the brain tissue. Sometimes bleeding can occur into the ventricles, which are chambers within the brain containing cerebrospinal fluid. Such hemorrhages can occur after head trauma or secondary to hypertension, and sometimes as bleeding within tumors. Hemorrhages observed after trauma are usually multiple and not very large. Secondary hemorrhages due to hypertension can be significant and affect vital brain regions called the basal ganglia. Intraventricular hemorrhages can occur due to high blood pressure, trauma, or bleeding from vascular pathologies such as AVM and aneurysms.

Symptoms: Common symptoms include headaches, nausea-vomiting, various types of paralysis (speech, muscle strength loss, etc.), clouding of consciousness, drowsiness, inability to wake up, and coma.

Diagnosis: Computed tomography (CT) is the best and fastest way to show trauma and hemorrhage. Magnetic resonance imaging (MRI) is used to evaluate the cause of hemorrhage and the condition of brain tissue. Angiography can be used to detect hemorrhages due to vascular pathologies.

Treatment: In cases of large, life-threatening parenchymal hemorrhages, surgery is performed to drain the blood. Intraventricular hemorrhages may require the placement of external ventricular drainage (EVD) to drain the blood. EVD involves placing a catheter into the chambers containing cerebrospinal fluid to allow its flow outside the body. To prevent re-bleeding in these patients, blood pressure normalization and control of systemic diseases like diabetes are necessary.

• Hypertension-Related Intracerebral Hemorrhage: This type of hemorrhage occurs without any vascular pathology and is caused by high blood pressure. It is generally seen in middle-aged individuals. Long-term high blood pressure, diabetes, kidney failure, smoking, and alcohol use are major risk factors. It occurs suddenly and can cause severe headache, weakness on one side of the body, speech disorders, seizures, noisy breathing, and coma depending on its location in the brain.

Treatment: Surgery or medication treatment is applied based on the neurological condition of the patient, the location, and the amount of hemorrhage. The purpose of surgery is to relieve the compressed brain by draining the blood. This procedure is called decompression. Patients with functional loss after treatment may need long-term rehabilitation in physical therapy. The hemorrhage is usually instantaneous, and bleeding stops by the time the patient arrives at the emergency room. The risk of recurrence is extremely low after the first attack.

• Subarachnoid Hemorrhage: Subarachnoid hemorrhage (SAH) is a type of bleeding between the brain tissue and the covering membrane of the brain. The most common causes of such hemorrhages are traumas and aneurysms (vascular bulges). It can also develop due to other vascular diseases such as tumors and arteriovenous malformations (AVM). A common complication of subarachnoid hemorrhage is the development of hydrocephalus, which is the enlargement of the chambers containing cerebrospinal fluid. The blood and blood products entering the subarachnoid space can block the small canals that allow cerebrospinal fluid absorption, leading to hydrocephalus. This condition can rapidly worsen the clinical picture.

Symptoms: The headache is very severe and sudden in onset. Patients typically describe the headache as the “worst headache of their life.” Nausea-vomiting, speech disorders, weakness, various types of paralysis, urinary and fecal incontinence, clouding of consciousness, and different degrees of coma can be observed.

Treatment: Treatment for subarachnoid hemorrhage is directed at the cause of the hemorrhage and potential hydrocephalus. In aneurysm-related hemorrhages, aneurysm treatment should be performed. In surgical treatment, the skull is opened, the aneurysm is isolated from surrounding tissues, and its neck is clipped to prevent blood from entering the aneurysm and causing hemorrhage. In endovascular treatment, the aneurysm is filled with special metals via a catheter inserted from the groin artery to prevent blood from entering the aneurysm and causing hemorrhage. The treatment method is chosen based on the aneurysm’s location, size, the patient’s general health status, the patient’s preference, and other factors. Subarachnoid hemorrhage can cause vasospasm, which is the constriction of brain vessels, leading to significant brain damage. Surgeries performed to stop bleeding do not prevent vasospasm alone. Therefore, intensive care and