What Is an Intracranial Hemorrhage?

Intracerebral hemorrhage (abbreviation: ICH) refers to hemorrhage caused by rupture of blood vessels in the brain. Therefore, at the same time as the brain cells receiving blood from blood vessels are damaged, the blood pressure forces the surrounding nerve tissue to cause obstacles. Intracranial hemorrhage is usually accompanied by hyperthermia. This symptom increases the amount of oxygen consumed in the brain, which in turn causes insufficient oxygen supply to the brain.

Chinese name: Intracranial hemorrhage

Foreign name: intracerebral hemorrhage
Department: neurosurgery

Overview of intracranial hemorrhage

Intracranial hemorrhage refers to bleeding caused by rupture of intracranial blood vessels. It can be divided into epidural hematoma, subdural hematoma, subarachnoid hemorrhage, cerebral hemorrhage, and ventricular hemorrhage according to different bleeding sites.

Intracranial bleeding symptoms

Coma, heartbeat, blood pressure, breathing instability

The heart center of a person's heartbeat, respiration, blood pressure, pulse, etc. are all in the brain stem, and brain stem bleeding will compress the center of life.

The different bleeding points will affect nausea, vomiting, diarrhea and other symptoms depending on the situation, with vomiting being the most severe.

If the bleeding point is not large, first observe for 48 hours, and do a ct review in time, or do a lumbar puncture to check whether there are red blood cells in the cerebrospinal fluid to confirm the bleeding absorption.

Causes and common diseases of intracranial hemorrhage :

1. Trauma: Head trauma can cause cerebral contusion and bleeding, cerebral hematoma or subarachnoid hemorrhage.

2. Hypertension: Hypertension often causes pathological changes in the small arteries of the brain. The prominent manifestation is the occurrence of vitreous or fibrous degeneration and focal bleeding, ischemia and necrosis on the walls of these arteries. The strength of the vessel wall is weakened, localized expansion occurs, and microaneurysms can form. The blood pressure rises sharply due to emotional excitement, excessive mental and physical labor, or other factors, resulting in ruptured bleeding of the cerebrovascular disease.

3. Hematological diseases: such as leukemia, hemophilia, sickle cell disease, different types of purpura, etc. Thrombocytosis can cause both thrombosis and bleeding.

4. Infection: Infection can cause cerebral arteritis, or bleeding caused by thrombocytopenia or DIC due to infection. Bacterial infection is the main cause, but virus and rickettsia can also cause arteritis. Rupture and bleeding of moldy aneurysms are sometimes seen.

Differential diagnosis of intracranial hemorrhage :

1. Change of consciousness: When there is intracranial hemorrhage, there are many conscious disturbances. The light person is lethargic and indifferent, and the severe person is quickly comatose.

2. Dyspnea: Those with large bleeding volume and obvious increase in intracranial pressure are prone to irregular breathing, and severe cases can cause respiratory failure.

3. Nervous system limitation: contralateral central hemiplegia is easy to see when bleeding in one side of the brain.

4. Meningeal irritation sign: Meningeal irritation sign may appear during subarachnoid hemorrhage, but it is not easy to check for meningeal irritation sign at the beginning or deep coma stage.

Intracranial hemorrhage examination:

1. Cerebrospinal fluid examination: Cerebrospinal fluid pressure generally increases when there is intracranial hemorrhage, so fine needles should be used for puncture. When the subarachnoid hemorrhage or intraventricular hemorrhage is cerebrospinal fluid are uniform bloody, the amount of protein increases. When the amount of bleeding is small, the appearance may only be turbid, but when examined under a microscope, a large number of red blood cells (including some shrunken red blood cells) are visible. Cerebrospinal fluid may be normal with only intracranial hemorrhage.

2. Ultrasound of the skull: The midline displacement can be seen when hematoma of the brain is formed.

3. Isotope brain scan: abnormal radioactive concentration.

4. CT examination: non-invasive examination method, can identify the location of the hematoma, can identify subarachnoid hemorrhage and intracranial hematoma, and whether the latter penetrates into the ventricle.

5. Cerebral angiography: used to determine the location and nature of hematoma or intracranial vascular malformations. This test is often performed when surgical treatment is considered possible.

6. Combined with clinical examinations for blood and urine: check for primary or secondary bleeding disorders.

Intracranial hemorrhage treatment principles:

Regardless of the type of intracranial hemorrhage, its treatment includes general treatment, medical treatment, surgical treatment and rehabilitation treatment.

(1) General treatment:

It mainly includes raising the head by 15 ~ 30 °, keeping the airway open, oxygen inhalation, ECG monitoring, maintaining a stable balance of water, electrolytes and acid-base, strengthening nursing, turning over regularly, patting the back, sucking sputum, preventing pneumonia and urinary tract infection And gastrointestinal complications.

(2) Drug treatment:

Including the rational use of hemostatic drugs to prevent continued bleeding; patients with cerebral hemorrhage should use intravenous antihypertensive drugs to quickly and safely control blood pressure; if cerebral edema and increased intracranial pressure symptoms are obvious, 20% mannitol and other drugs can be given to control intracranial pressure; according to Patient conditions, if necessary, preventive application of antibiotics and other drugs.

(Three) surgical treatment:

If the patient has a large amount of bleeding (superior curtain bleeding> 30ml, sub-temporal bleeding> 10ml), or the patient's consciousness is still exacerbated after drug treatment, surgical treatment should be considered as soon as possible. The surgical method needs to be selected in accordance with the general situation of the patient, the bleeding site, the amount of bleeding, and the bleeding time. Commonly used surgical methods include craniotomy to remove the hematoma, puncture aspiration hematoma, neuroendoscopic removal of the hematoma, and ventricular puncture drainage hematoma. Postoperative care should also be taken to maintain stable blood pressure, control the increase in intracranial pressure, and prevent various complications, such as lung infections, gastrointestinal bleeding, urinary tract infections, and renal failure.

(4) Recovery treatment:

Once the patient's condition is stable, rehabilitation should be performed immediately such as consciousness, exercise, language, and psychology. Massage and passive movements of paralyzed limbs are performed early, and active movements are gradually performed; speech rehabilitation training should be strengthened for patients with aphasia.