Brain Haemorrhage

Brain Haemorrhage

A cerebral hemorrhage, also known as a brain hemorrhage or intracerebral hemorrhage (ICH), is a type of intracranial hemorrhage that occurs within the brain tissue itself. It can result from brain trauma or occur spontaneously as in a hemorrhagic stroke. Non-traumatic intracerebral hemorrhage refers to spontaneous bleeding into the brain tissue.

This type of hemorrhage is categorized as an intra-axial hemorrhage, occurring within the brain tissue rather than outside of it. Contrastingly, extra-axial hemorrhages such as epidural, subdural, and subarachnoid hematomas occur within the skull but outside of the brain tissue. Intra-axial hemorrhages are further classified into intraparenchymal hemorrhages and intraventricular hemorrhages. Intraparenchymal bleeds are particularly concerning medical emergencies as they can raise intracranial pressure, potentially leading to coma and death. The mortality rate for intraparenchymal bleeds exceeds 40%.

Symptoms of intraparenchymal bleeds vary based on the affected area of the brain, often manifesting as signs of increased intracranial pressure due to the pressure exerted by the hemorrhage on the brain. Severe headache followed by vomiting is a common symptom, with some patients progressing to coma before the bleed is detected.

Several factors contribute to the development of intraparenchymal bleeds, with hypertension being a significant risk factor, elevating the risk by two to six times. Trauma, aneurysm rupture, arteriovenous malformation, and bleeding within a tumor are among the causes. Additionally, amyloid angiopathy is a notable cause in older patients. Risk factors for intraparenchymal hemorrhage include hypertension, diabetes, menopause, smoking, and alcohol consumption.

Diagnosis of intraparenchymal hemorrhage is typically achieved through CT scans, where blood appears brighter than other brain tissue. Treatment varies based on the type of hemorrhage, with rapid imaging and diagnostic measures guiding appropriate treatment, which may include medication and surgery.

Prognosis for intraparenchymal bleeds depends on various factors, with bleeds occurring in critical areas such as the brain stem carrying a high risk of mortality. Spontaneous intraparenchymal hemorrhages have a mortality rate ranging from 34% to 50% within 30 days after the event, with a significant portion of deaths occurring in the initial two days.

Research on the inflammatory response triggered by stroke has expanded to include mast cells, beyond the previously studied blood-borne leukocytes, neutrophils, macrophages, and resident microglia and astrocytes.