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Intracerebral hemorrhage treatment
How is intracranial hemorrhage treated?
Any type of bleeding inside the skull or brain is a medical emergency. It is important to get the person to a hospital emergency room immediately to determine the cause of the bleeding and begin medical treatment.
If a stroke has occurred, the cause (bleeding or blood clot) must be determined so that the appropriate treatment can be started. Prompt medical treatment can minimize damage to the brain, thereby improving the patient's chance of recovery.
The patient will stay in the stroke unit or intensive care unit (ICU) for close monitoring and care.
- If the patient was on blood thinners, reversal drugs will be given to restore clotting factors.
- Blood pressure is managed to decrease the risk of more bleeding yet provide enough blood flow (perfusion) to the brain.
- Controlling intracranial pressure is a factor in large bleeds. A device called an ICP monitor may be placed directly into the ventricles or within the brain to measure pressure. Normal ICP is 20mm HG.
- Removing cerebrospinal fluid (CSF) from the ventricles helps control pressure. A ventricular catheter (VP shunt) may be placed to drain CSF fluid and allow room for the hematoma to expand without damaging the brain.
- Hyperventilation also helps control ICP. In some cases, coma may be induced with drugs to bring down ICP.
Surgery may be necessary in the following situations:
- Hemorrhage may require immediate decompression of the brain to release pooled blood and relieve pressure. Decompression may be done through a burr hole procedure (drilling a hole in the skull to allow blood drainage), a craniectomy incision (partial removal of the skull to allow the swelling brain to expand), or a craniotomy (opening of the skull cavity).
- Hemorrhage caused by a ruptured cerebral aneurysm requires clipping of the aneurysm through a craniotomy surgical procedure, as soon as the patient's neurological condition permits.
Other treatments may include:
- Anti-anxiety drugs and/or medication to control blood pressure
- Anti-epileptic drugs for seizure control
- Other medications necessary to control other symptoms, such as painkillers for severe headache and stool softeners to prevent constipation and straining during bowel movements
- Nutrients and fluids as necessary- These may be given through a vein (intravenously), or a feeding tube in the stomach (gastronomy tube), especially if the patient has difficulty swallowing
Craniotomy involves cutting a hole in the skull with a drill to expose the brain and remove the clot. Because of the increased risk to the brain, this technique is usually used only when the hematoma is close to the surface of the brain or if it is associated with an AVM or tumor that must also be removed.
Stereotactic clot aspiration is a minimally invasive surgery for large hematomas located deep inside the brain. The procedure uses a stereotactic frame to guide a needle or endoscope directly into the clot. Stereotactic guidance is like the GPS system in your car. It is a navigation based on your presurgical imaging scans. The CT scan helps pinpoint the best trajectory into the hematoma. In the OR, the surgeon drills a small burr hole about the size of quarter in the skull. With the aid of the stereotactic frame, a hollow cannula is passed through the hole, through the brain tissue, directly into the clot. The hollow cannula is attached to a large syringe to withdraw the liquid portion of the blood clot (Fig. 2). A smaller catheter is then inserted to continue draining over the next days to weeks (Fig. 3).
10 common questions about Intracerebral hemorrhage treatment
1Can you survive intracerebral hemorrhage?
Many patients who have experienced a brain hemorrhage do survive. However, survival rates are decreased when the bleeding occurs in certain areas of the brain or if the initial bleed was very large. If a patient survives the initial event of an intracranial hemorrhage, recovery may take many months
2Can cerebral hemorrhage be treated?
Treatment for bleeding in the brain depends on the location, cause, and extent of the hemorrhage. Surgery may be needed to alleviate swelling and prevent bleeding. ... These include painkillers, corticosteroids, or diuretics to reduce swelling, and anticonvulsants to control seizures
3What is the difference between intracranial and intracerebral hemorrhage?
An intracranial hemorrhage is a type of bleeding that occurs inside the skull (cranium). Bleeding around or within the brain itself is known as a cerebral hemorrhage (or intracerebral hemorrhage). Bleeding caused by a blood vessel in the brain that has leaked or ruptured (torn) is called a hemorrhagic stroke.
4What are 3 types of hemorrhage?
Note that there are three different types of hemorrhage in the same patient: subdural hematoma, intraparenchymal hemorrhage (from contusion), and subarachnoid blood.
5How long can you live with brain hemorrhage?
Hemorrhagic stroke is life threatening. Many of these deaths occur within the first two days. For those who survive a brain hemorrhage, recovery is slow. A minority of people are able to recover complete or near-complete functioning within 30 days of the stroke.
6How long do you live after a hemorrhagic stroke?
The survival rate after hemorrhagic stroke was 26.7% within a period of five years. Long-term survival rate prognosis is significantly better among the younger patients, without hypertension, alcohol intake and diabetes mellitus
7Why are hemorrhagic strokes worse than ischemic?
Those who suffer ischemic strokes have a much better chance for survival than those who experience hemorrhagic strokes, as hemorrhagic stroke not only damages brain cells but also may lead to increased pressure on the brain or spasms in the blood vessels 
8What is the life expectancy after a hemorrhagic stroke?
The estimated survival rate for hemorrhagic strokes is around 26.7%. If you think about it, that is basically 1 in every 4 people that have a hemorrhagic stroke. It is believed that a survival rate for diseases and conditions is life after 5 years after the stroke occurred or longer.
9What is the most common cause of intracerebral hemorrhage?
Intracerebral hemorrhage (ICH) is caused by bleeding within the brain tissue itself — a life-threatening type of stroke. A stroke occurs when the brain is deprived of oxygen and blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma.
10Is surgery necessary for brain hemorrhage?
Surgery may be necessary to treat a severe brain hemorrhage. Surgeons may operate to relieve some of the pressure on the brain. If a burst cerebral aneurysm causes a hemorrhage, a surgeon may remove part of the skull and clip the artery. This procedure is called a craniotomy.