Surgery

Brain Hemorrhage



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An intracerebral hemorrhage occurs when a blood vessel in the brain ruptures, releasing blood into the surrounding brain tissue. Intracerebral hemorrhages differ from strokes in that, in a stroke, a blood vessel becomes blocked and no blood reaches certain parts of the brain. The end result, however, may be similar. An intracerebral hemorrhage usually results in a blood clot that puts pressure on nearby tissues and forces nutrients out of them, leading to brain cell death. In extreme cases, intracerebral hemorrhages, like strokes, are swiftly fatal. In other cases the effects include initially localized but spreading brain tissue damage, which can lead to loss of motor control, speech, and perceptive ability. Intracerebral hemorrhages are most closely associated with high blood pressure.

Partly because many people are unaware that they have high blood pressure, intracerebral hemorrhages may not be noticed when they first occur if the blood vessel is small, the rupture is small, or the location of the rupture within the brain does not cause immediate, obvious damage. An intracerebral hemorrhage is usually first noticed when the patient starts having difficulty with perception or speech, or loses control of some of her muscles. The patient may also suddenly collapse and not be able to get back up. This is considered a semi-emergency and dialing 911 and getting the patient to the hospital immediately is important.

Once in hospital, most patients will receive surgical intervention. Doctors will request brain imaging to locate the rupture and blood clot within the brain. Surgery involves making a small hole in the skull and inserting the smallest possible instruments to remove the blood clot and secure the rupture in the blood vessel. The patient may be subjected to brain ultrasound during surgery and may receive injectible blood pressure lowering medications. Medications that minimize post-surgical bleeding are nearly always used.

Sometimes surgery for an intracerebral hemorrhage is not indicated. Very small hemorrhages resolve themselves within two months, so the patient may just receive monitoring and the administration of blood pressure reducers. If she is already taking blood thinners, those may be discontinued or reduced. Some candidates for surgery are also disqualified if they suffer from conditions that make surgery too dangerous, such as severe uncontrolled diabetes or significant kidney damage. There are also hemorrhages in certain locations, such as at the brain stem, that do so much damage so quickly that surgery would not significantly promote recovery and may do additional damage. In those cases, surgery is usually also not done.

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