Brain haemorrhages are also referred to as intracranial haemorrhages. This term refers to the cranium, the Latin word for skull. It therefore refers to all bleeding within the skull.
The effects on the brain and the resulting symptoms also depend on the extent and location of the bleeding. Doctors categorize hemorrhages according to the name of the limiting meninges:
- Epidural hemorrhage (epidural hematoma, EDH): Bleeding between the skull and the hard meninges (dura mater)
- Subdural hematoma, SDH: bleeding directly under the hard meninges and simultaneously over the soft meninges
- Subarachnoid hemorrhage, SAB: Bleeding underneath the arachnoid membrane (soft meninges).
- Intracerebral hemorrhage, ICB: bleeding in the substance of the brain
Cerebral hemorrhages are named according to the adjacent meninges © songkram | AdobeStock
All four types of cerebral hemorrhage mentioned above can occur as a result of trauma. Intracranial hemorrhages in the area of the meninges (epidural hematoma and subdural hematoma) are particularly common as a result of head trauma. These include
- Traffic, sports and work accidents,
- violent crimes involving blows or blows to the head.
Intracerebral cerebral hemorrhage
High blood pressure is the most common cause of intracerebral hemorrhage. Elevated blood pressure levels over a longer period of time damage the blood vessels. This can cause them to rupture and trigger a cerebral hemorrhage.
Other risk factors that favor a cerebral hemorrhage are
- advanced age,
- smoking tobacco
- excessive alcohol consumption,
- the consumption of hard drugs,
- a high blood lipid level,
- lack of exercise,
- brain tumors and
- vascular malformations.
Intracerebral hemorrhage shows similar signs of illness as a stroke. This results from a circulatory disorder. The symptoms are
Loss of consciousness is also possible.
Subarachnoid hemorrhage
Head trauma often leaves behind a more or less pronounced subarachnoid hemorrhage. In some cases, however, a ruptured aneurysm is responsible for this type of bleeding.
An aneurysm is a sac-shaped dilation of a blood vessel (arterial or venous). It is caused by a local wall weakness in the area of a branch of an arterial vessel in connection with
A subarachnoid hemorrhage is characterized by the sudden onset of a particularly intense headache. It is accompanied by neck pain or a stiff neck.
The symptoms usually begin during intense physical exertion. Other symptoms are
- Nausea,
- vomiting or
- clouding of consciousness.
Subdural hemorrhage
Subdural hematomas can occur in two forms:
- acute as a fresh hemorrhage or
- chronic as a prolonged hemorrhage.
Chronic subdural hematoma mainly affects older people. The cause is the dwindling brain volume and the resulting increasing pressure on the so-called bridging veins. Chronic subdural hematomas develop slowly over several weeks.
In most cases, a mini-trauma to the head is the trigger, in some cases there was no relevant trauma at all. Blood-thinning medication increases the risk of a chronic subdural hematoma.
Chronic subdural hematomas can persist for a long time without clinical deficits. Possible symptoms are
- Headaches,
- a feeling of pressure in the head,
- dizziness or
- new cognitive changes.
Focal neurological deficits or impaired consciousness are also possible.
Acute subdural hematoma is usually caused by a more serious accident in which blood vessels in the subdural space are injured.
The clinical symptoms of an acute subdural hematoma include
Specific symptoms are
- Speech disorders,
- seizures or
- paralysis on one side.
These are observed in particular when pressure is applied to the brain. These deficits are very similar to the symptoms of epidural hematomas.
Epidural hemorrhage
The most common cause of an epidural hemorrhage is a skull fracture with injury to an artery of the hard meninges. Very often an accident is the trigger. The hematoma only spreads within the cranial sutures.
An epidural hemorrhage is usually accompanied by unconsciousness directly after a trauma.
Rather rarely, but characteristically, the patient can wake up again after a head trauma and be relatively symptom-free for a few minutes. This is known as a free interval. A little later, there is typically
- headache,
- nausea,
- vomiting and
- neurological deficits with subsequent clouding of consciousness.
The effects of a cerebral hemorrhage can be fatal. That is why rapid action is necessary. The later the patient is treated, the more likely it is that the cerebral hemorrhage will lead to death.
The emergency doctor should therefore be called at the slightest suspicion !
A CT scan (computer tomography) of the head provides information about the location of the hemorrhage. A clinic with a neurosurgery department should be consulted for further treatment.
There is always a risk of brain swelling with cerebral hemorrhages. The resulting increase in intracranial pressure affects the entire body. The result is an undersupply of blood to the brain. Various measures can be taken to counteract this:
- Artificial respiration,
- lowering the blood pressure with medication or
- dehydrating infusions
are the first treatment steps. The volume of cerebrospinal fluid and thus also the intracranial pressure can be regulated with these or with an external cerebrospinal fluid drainage system.
Major hemorrhages cause extreme intracranial pressure and are therefore usually removed surgically.
During the operation, the surgeon opens the skull bone at the affected area. He then removes the haematoma and stops the cause of the bleeding.
Despite prompt treatment, in some cases patients can still die.
This means that all intracranial hemorrhages are serious illnesses. They require emergency treatment.
Depending on the location of the cerebral hemorrhage, different neurological damage may result. Hemiparesis is particularly common, with reduced sensory perception and strength on one side of the body. Some sufferers only experience slight gait instability. Others, however, struggle with extensive paralysis.
Incomplete hemiparesis affects the face as well as the arms and legs.
Further consequences can include
- impaired coordination of movement (ataxia),
- problems with more complex movement sequences (apraxia) as well as
- and reduced attention on one side of the body.
can occur.
Rapid treatment in hospital is usually followed by neurological rehabilitation. This serves to improve the chances of success after emergency treatment.
The various areas affected, such as
- Speech,
- vision,
- concentration or
- movement
require good cooperation between therapists from different medical disciplines:
- Occupational therapy
- physiotherapy
- Physical therapy
- speech therapy
- Neuropsychology
- Case management (social services)
The prognosis for recovery depends, among other things, on the size and extent of the hemorrhage. The patient's state of consciousness on admission to hospital is also important.
Some of those affected recover fully after the cerebral hemorrhage. However, the majority of those affected are only partially able to cope with everyday life on their own, or only after several months or years.
