Brain Hemorrhage

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A brain hemorrhage describes a serious condition of bleeding in the brain tissue or on the surface of the brain. Medical professionals refer to this as a cerebral hemorrhage, cerebral bleed, or hemorrhagic stroke.

There are two types of cerebral hemorrhage, intracerebral and subarachnoid. An intracerebral hemorrhage  happens within the brain tissue,  when one of the cerebral arteries in the brain bursts, and the surrounding tissue fills with blood.

Frequently the cause of this type of bleed is due to a change in the arteries from chronic hypertension or high blood pressure. The accumulation of the blood from the burst artery adds pressure, known as intracranial pressure, to the brain tissue. Depending on the amount of the increased pressure, neurological deficits will occur, ranging from mild to severe. 

In some instances, you can die from the increased intracranial pressure. If you survive, generally you will recover more neurological function than someone who experiences an ischemic stroke (one caused by a blood clot). This is because eventually the pressure on the brain will decrease as the blood reabsorbs, and you will be able to regain some of the former functions.

A subarachnoid hemorrhage occurs when a blood vessel on the brain's surface ruptures and bleeds into the subarachnoid space, which is the space between the brain and the skull (but not into the brain itself).  The most common cause of subarachnoid hemorrhage is a burst aneurysm. Subarachnoid hemorrhage, due to a ruptured aneurysm, occurs most commonly in the 20 to 60 age group. Approximately one in 15 people in the United States develop this life-threatening diagnosis, and it occurs slightly more often in women than in men. Approximately one to three percent of these aneurysms rupture each year.  This equates to over 30,000 people per year in the United States alone.

The initial goal of treatment is to save the patient’s life, and this is crucial as ten to fifteen percent of these patients do not live long enough to reach the hospital, and over 50 percent die within the first month.

Other treatment goals consist of locating the source of the bleeding, and repairing it if possible. Surgery is a treatment option, in cases of injury to remove large collections of blood or to relieve pressure on the brain. The other treatment goals are relieving symptoms, and preventing further complications such as permanent brain damage.

According to the statistics from the National Stroke Association, of those who survive beyond the first thirty days, half experience some permanent neurological deficits.

Another less common cause for a subarachnoid hemorrhage can be the rupture of an arteriovenous malformation. This congenital condition involves entangled blood vessels. These malformations are most likely to bleed in people between the ages of ten and 55, after which time the bleeding chances diminish. When an AV malformation bleeds, it is with a limited amount of blood, as opposed to the hemorrhagic strokes caused by hypertension.

Only twenty per cent of all strokes are due to a brain hemorrhage, compared with ischemic strokes, which are due to a blood clot. Although a brain hemorrhage is less common than an ischemic stroke, the incidence of death is usually higher. 

There is some controversy now as to the treatment guidelines involving the use of blood thinners and the risk of a brain hemorrhage. More research is continuing in this area.

More about this author: Margie Miklas

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