Cerebral hemorrhage

Under a cerebral hemorrhage doctors understand various bleeding of the human brain. It is therefore a generic term. In the human medical literature, a distinction is made between intracranial hemorrhage (cerebral hemorrhage inside the skull), intracerebral hemorrhages (hemorrhages that occur directly in the area of the brain) and extracerebral hemorrhages (meningeal hemorrhages) distinguished.

Definition: What is actually a cerebral hemorrhage??

Doctors distinguish between three different cerebral hemorrhages:

From a intracerebral cerebral hemorrhage is spoken when the hemorrhage directly in the area of the brain occurs. Usually intracerebral hemorrhages are not caused by traumatic circumstances such as accidents, but occur suddenly. The characteristic feature of this hemorrhage is its location in the brain tissue, the so-called parenchyma. Depending on the cause, intensity and localization of the bleeding, a further classification is possible.

In contrast to intracerebral hemorrhages occur intracranial hemorrhages inside the skull at. Here it can be, z. B. after craniocerebral trauma, to bleeding between the brain and the cranial bones, a epidural hematoma come. Functional consequences occur due to the mass and the pressure on different brain regions in each case.

Extracerebral Cerebral Hemorrhage form the third type of hemorrhage. The literature divides these again into two subgroups a. If the affected person develops a hematoma below the meninges, it is called a cerebral hemorrhage Subdural hemorrhage Also referred to as a subdural hematoma. In contrast subarachnoid hemorrhage underneath the spider’s web (arachnoid) outside the brain. In this hemorrhage, clustered by vascular bulges (aneurysms) of the blood vessels of the brain, blood is detectable in the cerebrospinal fluid (CSF).

Difference between a cerebral hemorrhage and a stroke

Bleeding in the head are called cerebral hemorrhages. In the event of a stroke (cerebral apoplexy), certain areas in the brain are not supplied with sufficient oxygen. In the case of a stroke, there is a lack of blood supply, but no blood leaks out. A cerebral hemorrhage in one area of the brain (z. B. aneurysm) can, however, be the cause of an undersupply of blood or cerebrospinal fluid to another area of the brain. oxygen and thus trigger a stroke. Notably, however, cerebral hemorrhage leads to functional dysfunction through local damage to brain tissue and secondarily through its space-occupying effects and displacement of healthy brain tissue. Here the brain tissue can only escape to a limited extent because it is limited by the rigid skull bone.

Illustration of a hemorrhage in the human brain

Symptoms: How to recognize a brain hemorrhage

Brain hemorrhages lead to massive impairment of physical integrity. The majority of those affected complain of nausea, vomiting and headache.

Cerebral hemorrhages can be accompanied by stroke, which is why the typical symptoms of a stroke can also indicate a cerebral hemorrhage. These are:

  • acute paralysis
  • sudden, severe general malaise and weakness
  • sudden dizziness and coordination problems
  • sudden speech and sensory disturbances
  • sudden visual disturbances and problems with breathing
  • acute unconsciousness and disturbances of consciousness

Diagnosis of a brain hemorrhage

Cerebral hemorrhages cannot be diagnosed solely by assigning objective symptoms, since they are not visible externally. Therefore, a reliable diagnosis always requires the performance imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) or, less commonly, vascular imaging (angiography).

The standardized initial treatment usually resorts to a CT scan back, as the procedure results faster than an MRI provides. Both CT and MRI enable the treating physicians to determine the location and size of the cerebral hemorrhage. changes in size can be detected by repeating the imaging procedure at a later time.

According to the current state of medicine MRI examinations indicated especially when the patient has been stabilized, because unlike a CT, an MRI can also visualize older hemorrhages as well as aneurysms or similar malformations.

Course of the disease and prognosis

The course of a cerebral hemorrhage is strongly dependent on the individual case. Major Factors, which have a massive influence on the course of the disease, are

  • the age,
  • the general condition,
  • possibly existing underlying diseases as well as especially
  • the location and type of cerebral hemorrhage.

Medical studies have shown that Mortality rate for minor brain hemorrhages between 30 percent and 50 percent (lethality rate) located at. Extensive cerebral hemorrhage is even more likely to result in death. In a large number of patients who survive a brain hemorrhage, the following occurs Long-term to permanent sequelae such as

  • paralysis of arm and leg,
  • Speech disorders (speaking and understanding),
  • Disturbances of attention, memory and planning ability (so-called. neuropsychological disorders) and
  • further mental or physical impairments.

Treatment of a cerebral hemorrhage

Brain hemorrhages are medical emergencies. Consequently, the factor of time plays a significant role in the treatment. The longer it takes to initiate adequate treatment, the higher the likelihood of death or for sequelae to persist. In case of a concrete suspicion of a cerebral hemorrhage, therefore, the nearest hospital must be visited immediately or. calling the emergency doctor. The clinic should have medical equipment (stroke unit) that allows for appropriate diagnosis and treatment.

At the beginning of acute treatment, doctors first try to prevent the stabilize patients. Since the brain functions of the affected u.a. If the patient’s respiratory center is impaired, they often have to be artificially ventilated. If the cerebral hemorrhage results in a increase in intracranial pressure, surgery must be initiated as a matter of urgency. During this surgery, neurosurgeons open part of the skull bone to stop bleeding and remove bruises. To compensate for massive blood loss, the administration of blood units may be necessary.

Rehabilitation after acute treatment

When the patient has survived the critical phase, rehabilitative treatment begins Long-term treatment. Here, various measures are introduced to limit the extent of the consequential damage and to prevent further bleeding. Through comprehensive rehabilitation measures, therapists, nursing staff (therapeutic-activating care) and physicians try to eliminate mental and physical dysfunctions or to improve the quality of life. limit their impact on the quality of life. The sooner the rehabilitation measure begins in a neurological specialist clinic, the greater the chance of avoiding or reducing the consequential damage of a brain hemorrhage.

During rehabilitation, affected persons naturally receive medical care. In addition to the medical consultation and advice, the Adapted medication for this.

Our brain controls and monitors physical and mental functions. Therefore, paralysis, sensory disturbances, but also speech and memory disorders are possible as a consequence. In the Rehabilitation they are intensively examined and treated. The brain remains capable of learning until old age. It is scientifically assumed that spared areas of the brain take over tasks and rather slightly damaged regions can even partially recover.

Brain hemorrhages can affect people at any age.

children and adolescents usually require special neuropediatric rehabilitation. The still-developing body and mind need therapies appropriate for children. Caregivers and parents often also need long-term support in coping with the disease. In a neuropediatric rehabilitation clinic or other facility, they are included in the therapy concept for their children. In some cases, a change of school is also necessary in severe cases. In the course of rehabilitation, the children and adolescents are also often taught in a "clinic school teaches.

Achieving the rehabilitation goals

A prerequisite for achieving the rehabilitation goals is targeted Practice with therapeutic help and the development of a good Self-assessment of the affected person. Since our brain also determines our personality and thus our ability to self-assess, a brain hemorrhage can also lead to a misjudgment of the own abilities. Therapists, specialized nursing staff and physicians help patients and their relatives to perform the correct exercises and to develop an appropriate perception of their own strengths and weaknesses.

The modern therapy is carried out by many highly specialized therapists who intensively and regularly coordinate. Occupational therapy, physiotherapy, sports therapy, art and music therapy, speech therapy, balneo-physical therapy, neuropsychology and clinical psychology, garden therapy as well as remedial education/pedagogy are available to help affected persons.

Today’s therapy uses modern Robotics-assisted Devices, for example, to improve walking or arm functions (grasping, etc.).) to improve. Regular repetition helps the brain to relearn lost skills. To improve mental functions (attention, memory, planning ability, problem solving and language), scientifically verified methods, for example in neuropsychology, are also used. Often modern computer programs are used.

Very important are also own exercises of the affected persons. Therapists provide specific instructions for this – also for self-training after the hospital stay.

Rehab after cerebral hemorrhage: child does gait training with therapist in the Lokomat of VAMED Klinik Hattingen

Perspective

Severe brain hemorrhages change the Life perspective and plans. Psychologists, social workers and physicians support affected persons and the family in the development of perspectives. The primary goal is the return to the family environment, to the workplace or to school life, in order to enable those affected to be as independent as possible. If necessary, applications for aids or structural changes in the own four walls, for socio-legal measures or for support with care are already made during the rehab stay. Familial care training courses and care training intensively prepare relatives for the new situation of care at home. If it is not yet possible to return to the home environment after the hospital stay, accommodation in an aftercare facility is organized by the rehabilitation clinic in consultation with the relatives. Medications are also prescribed, if needed, to improve mood.

Of course, the Planning the withdrawal and initial organization of further medical and therapeutic measures among the tasks of rehabilitation. The clinic’s social services provide support for those affected. In addition to partial inpatient and outpatient offers, repeated inpatient rehabilitation may also be indicated here if necessary.

Depending on the severity of the cerebral hemorrhage, it may take several years before the affected person is able to care for himself independently again. Patience, perseverance, initiative and the support of relatives are strongly required.

In some cases, however, irreversible residual symptoms remain. In some cases, permanent home care or even institutionalization is then necessary.

On the subject of Fitness to drive of a motor vehicle on public roads is not possible for at least three to six months after surgically treated brain hemorrhages. In all other cases, an individual decision must be made below.

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