Spontaneous brain hemorrhage accounts for about 10% of all strokes and is fatal in about 50% of the cases. Its incidence, in contrast to other types of strokes, has not declined. According to Dr. Rahul Gupta, Senior Neuro and Spine surgeon at Fortis Hospital, Noida, Hypertension accounts for about half of these hemorrhages; the rest are due to tumors, aneurysms and vascular malformations, inflammatory and degenerative vasculopathies and hematologic and iatrogenic disorders of coagulation.
Brain haemorrhage is bleeding into the brain tissue or its surface due to rupture of blood vessel. It can be spontaneous or due to head injury.
Symptoms of Brain haemorrhage
Most often presentation is sudden severe headache, vomiting and transient unconsciousness. Sometimes, headache may be gradually progressive and associated with limb weakness or epileptic attack (seizure).
Reasons for Spontaneous Brain haemorrhage?
It is usually associated with high blood pressure (BP). Different types of brain haemorrhage may have different reasons.
Different types of brain haemorrhage?
Intracranial haematoma (ICH) is frequently seen in people with uncontrolled high BP. Sometimes, it may be due to defect in vessel wall (like aneurysm, AVM). Uncommonly, a brain tumour may also develop an ICH. Another type of haemorrhage may be Subarachnoid haemorrhage (SAH) which is due to aneurysm supture. Another type is subdural hematoma (SDH) which is due to trauma or consumption of blood thinners.
Diagnosis of Brain haemorrhage
CT scan is the investigation of choice. Angiography of brain helps to identify cause of bleeding. Sometimes MRI is required to look for bleeding inside tumour.
Treatment of ICH
A6. Small ICH can be managed with medicines. Surgery is required if the ICH is large, causing pressure effect on brain and if the patient is unconscious.
Treatment of SAH
In 90% cases, SAH is due to aneurysm supture. Angiography is mandatory to identify aneurysm. There are 3 types of angiography. Digital Subtraction Angiography (DSA) done in Neurocathlab is the best method. Others are CT or MRI based angiographies. After diagnosis, aneurysm needs to be secured by clipping or coiling to prevent re-rupture. Vasospasm (shrinkage of blood vessels) is a dreaded complication of SAH, which may lead to neurological deficits. It is managed with medicines.
Coiling or Clipping of Aneurysm
These are methods to prevent re-rupture of an aneurysm. Coiling is done in Neurocathlab, where without opening the skull, the aneurysm is packed with coils. It is a relatively new method with excellent results. In clipping, the skull is opened, aneurysm is exposed and a clip is placed across its neck. This is a time tested method and provides permanent cure.
Trreatment of SDH
SDH is usually seen after trauma. Chronic (late) SDH may present with subtle symptoms, many weeks often minor trauma and is common in elderly. It may occur in patients consuming blood thinners like Ecosprin. Reversal of blood thinning effect is essential before surgery. Chronic SDH needs two holes in skull and drainage under local anaesthesia.
Prognosis of brain haemorrhage
In small ICH, patient recovers well in 3-6 months with minor deficits. In large ICH, patient needs prolonged hospitalisation and rehabilitation and chances of recovery depends on delay in treatment given to the patient. In SAH, if patient conscious before surgery then recovery is very good. Chronic SDH patients do very well within a week time.
Bleeding inside Tumours
Some brain tumours may present with bleeding inside them. MRI helps in diagnosis. Removal of tumour along with blood is the treatment. Without any delay, patient should be taken to a hospital equipped with facilities of CT scan, MRI and Angiography.
Tips for prevention
Most important is frequent monitoring and control of blood pressure with medication and lifestyle modification. Brain haemorrhages are more frequent in early morning especially in winters. Drinking lot of water and timely consumption of medicines is essential. Minor headaches should not be neglected and a Neurosurgeon/Neurologist should be consulted.
Burden of Brain haemorrhage on the population
Spontaneous brain haemorrhage is very common and almost 50% patients expire before they can be shifted to a tertiary care hospital. Patients who are unconscious before surgical treatment take months to recover. Unfortunately, there are few centres for rehabilitation in India and patient has to be shifted home after definitive treatment. Hence, role of prevention and timely intervention cannot be overemphasised.
Dr. Rahul Gupta is Senior Neuro & Spine surgeon at Fortis hospital, Noida
Dr. Rahul Gupta is the man behind the department of Brain and spine surgeon at Fortis Hospital, Noida. He was trained at Nagoya Japan, which has made him an expert in Endovascular procedures.
He worked in many government hospitals including PGIMS, Rohtak, PGIMER Chandigarh & Govind Ballabh Pant institute of Postgraduate Medical Education & Research, New Delhi.
Dr. Rahul Gupta has performed surgeries on hundreds of patients with head and spine injury. He has treated numerous complex spine ailments like metastatic tumors, osteoporotic fractures (vertebroplasty), degenerative diseases and listhesis.
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