Brain hemorrhage refers to bleeding into the brain tissue (intracerebral) or between the membranes surrounding it and bone (subarachnoidal, subdural, epidural). All of these bleedings can be traumatic, that is, after a blow to the brain for any reason, or they can occur as a result of hypertension and any other systemic disease.
INTRACEREBRAL BLEEDINGS:
It is the leakage of blood into the brain and destruction of the brain tissue as a result of tearing the walls of the vessels feeding the brain, especially the small vessels in certain regions. There are approximately 12-15 cases among 100,000 people each year, and this rate increases over the age of 40. The male to female ratio is 11.67. The risk factors are hypertension, amyloid angiopathy, trauma, alcohol and nicotine. aspirin, nonsteroidal anti-inflammatories and thrombolytic agents may also cause it. As the age progresses, the cerebral vessels wear out and lose their elastic properties. The walls of these vessels, which have lost their elasticity as a result of diseases such as hypertension and amyloid angiopathy, are torn and blood leaks into the brain tissue. This blood accumulates in the brain tissue and creates a mass effect and destroys the brain tissue. At the same time, this mass effect causes ischemia by disrupting the circulatory system of the brain.
Clinically, it usually presents with one-sided loss of strength, headache and changes in consciousness. In addition, speech disorder, seizures, nausea and vomiting can also be seen.
A detailed history should be taken for preliminary diagnosis. Computed tomography and magnetic resonance imaging methods from radiological examinations are used in diagnosis. Computed tomography is more preferred because of its short duration and better diagnostic ability.
The first thing to do in treatment is to maintain the respiratory and circulatory system in order to protect the vital functions of the patient. The size of the bleeding, its localization in the brain, and the neurological picture of the patient are evaluated and it is decided whether the treatment will be surgical or medical. The surgical treatment is to evacuate the blood that has accumulated in the brain tissue and create a mass effect, and to stop the bleeding. As medical treatment, they are drugs to be used to reduce intracranial pressure and to reduce edema around bleeding. Antiepileptic drugs, which prevent the patient from having a seizure, are also started as a preventive measure.
SUBARACHNOID BLEEDING:
Bleeding under the arachnoid membrane surrounding the brain. Its incidence is 10-16100000. Risk factors are familial, smoking, alcohol, hypertension, drug habits such as oral contraceptives, cocaine, amphetamine. The most common causes are aneurysm, as well as hypertension, atherosclerosis, arteriovenous malformations, brain tumors, bleeding disorders, encephalitis, meningitis, meningoencephalitis, complications of anticoagulant therapy, head trauma and unknown causes.
Findings are most commonly severe headache and nuchal rigidity. In addition, nausea, vomiting, dizziness, double vision, seizures, blurred consciousness and accompanying intracerebral hemorrhage may be findings. Diagnosis is the detection of bleeding with computerized tomography, which gives rapid results at first. After the detection of bleeding, angiography to be done to view the brain vessels is required.
If an aneurysm is detected as a result of angiography, then the aneurysm should be excluded from circulation by surgical or endovascular methods, depending on its location and configuration.
Despite all the developments, today, 25-30% of these patients die before they reach the hospital, and 30-50% of the rest cannot be saved.
EPIDURAL HEMATOM:
Bleeding between the thick membrane of the brain (dura) and the bone, which occurs due to trauma. They occur as a result of damage to the vessels on the dura after trauma, usually accompanied by a fracture of the skull bone. They are seen in 0.2-0.6% of all head traumas. The clinic appears in three forms, the first is the lucid interval (opening and closing of consciousness), the second is completely closed and never opened, and the third is in the form of blurred consciousness. Diagnosis is made by computed tomography, magnetic resonance imaging can also be used in the diagnosis, but computed tomography is preferred because it gives much earlier results and time is of vital importance.
Treatment is follow-up or surgery depending on the amount of blood accumulating between the dura and the bone and the degree of pressure on the brain. If there is a very small amount of blood accumulation, the patient can be followed up under close observation. If the decision is surgical, it should be implemented very quickly. Surgically, the blood between the dura and the bone is drained and the bleeding focus is found and stopped. The results after surgical treatment are promising. Good result after treatment ranges between 55-89%, mortality ranges between 5-29%.
SUBDURAL HEMATOM
Subdural hematoma is seen in 8-57% of patients with head trauma. It is the accumulation of blood due to damage to the vessels between the dura and the brain tissue. In 50% of the cases with subdural hematoma, there are additional pathologies in the brain. Generally, patients come with very serious neurological disorders and 50% of the patients are unconscious. The best method for diagnosis is computed tomography, magnetic resonance imaging can also make the diagnosis.
Treatment of hematomas with mass effect and neurological disorders is surgery. Surgically, the accumulated blood between the brain and dura is drained and the bleeding focus is found and controlled. Mortality rate varies between 42-90%, this rate is much higher than epidural hematomas.
