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Op. Dr. Selçuk Gözcü Beyin Sinir ve Omurilik Cerrahisi

BRAIN BLEEDINGS

Brain hemorrhage, which can occur due to high blood pressure, especially in elderly people, can actually occur in all age groups in many different ways. Head traumas, cerebral vascular aneurysms, popularly known as bubbles, and vascular bundle disease are also among the leading causes of brain hemorrhages. Brain tissue is the most important organ of the body, protected from external influences in an area surrounded by bones. While this protection area is an advantage in normal times, it can turn into a disadvantage in cases of cerebral hemorrhage. The reason for this is that this closed bone structure called the skull, which does not have the ability to expand, can lead to compression on the brain tissue in sudden events and some deterioration symptoms that progress to sudden death. Normally, there is a balanced ratio of brain tissue, blood and cerebrospinal fluid inside the skull. In slowly developing conditions, the amount of cerebrospinal fluid or blood decreases, and the pressure inside the skull is kept constant so that it does not disturb the brain tissue. There are some protective mechanisms that provide this. However, in sudden events, these protective mechanisms cannot work and the brain is crushed in the skull and becomes unable to function by being under pressure.

WHAT IS BRAIN BLEEDING?

Brain hemorrhage can be defined simply as bleeding that occurs inside the skull. Bleeding can occur as a result of blood leaking out of the vessels in the skull, as well as on the brain tissue and brain surface. The resulting bleeding can spread into the brain tissue or between the meninges and the skull bone. Cerebral hemorrhages, which can result in death, can occur inside the skull, outside the brain tissue, or inside the brain tissue. The common result here is the pushing and compression of the brain tissue. Brain hemorrhage can be defined simply as bleeding that occurs inside the skull. Bleeding can occur as a result of blood leaking out of the vessels in the skull, as well as on the brain tissue and brain surface. The resulting bleeding can spread into the brain tissue or between the meninges and the skull bone. Cerebral hemorrhages, which can result in death, can occur inside the skull, outside the brain tissue, or inside the brain tissue. The common result here is the pushing and compression of the brain tissue.

WHAT ARE THE SYMPTOMS OF BRAIN BLEEDING?

Symptoms of brain hemorrhage can occur in different ways. Symptoms of cerebral hemorrhage may vary depending on the location, amount and amount of tissue affected. Symptoms of brain hemorrhage usually tend to come on suddenly. In addition to rapidly developing symptoms, symptoms may occur hours or even days after a brain hemorrhage. Symptoms of cerebral hemorrhage may gradually worsen.

Severe headache is among the most common symptoms of cerebral hemorrhage. Headache due to cerebral hemorrhage is very severe, unlike stress-type pain experienced in daily life, and the patient describes this as a pain he has never experienced before.

Sudden tingling, weakness, numbness or paralysis in the face, arm or leg, especially on one side of the body, can be a sign of cerebral hemorrhage.

Problems such as nausea and vomiting can be caused by many different ailments and should also be considered as a symptom of sudden cerebral hemorrhage.

Blurring of consciousness, dizziness are among the symptoms of cerebral hemorrhage.

Epileptic seizures can also be caused by different diseases. However, it can also be seen as a symptom of cerebral hemorrhage. Frequent distractions can also mean seizures.

Difficulty swallowing or difficulty seeing are among the symptoms of cerebral hemorrhage.

Loss of balance or coordination are among the symptoms that should be evaluated for cerebral hemorrhage.

Inability to control eye movements correctly can be a sign of cerebral hemorrhage.

Abnormal or slurred speech or difficulty in reading, writing or understanding can be caused by a brain hemorrhage.

Changes in consciousness or alertness, lack of energy, drowsiness or coma are among the symptoms of cerebral hemorrhage.

Whistling, ringing, or the sound of a running clock from the ear may be a sign of cerebral hemorrhage.

In cases where the bleeding is in the brain stem, symptoms such as troubled breathing and abnormal heartbeat can be seen.

Symptoms of cerebral hemorrhage in babies;

It is important for parents to closely monitor signs of cerebral hemorrhage in infants or children. Especially after a head trauma, careful observation of the baby or child is necessary.

In addition to headache, children who can express themselves can be a symptom of cerebral hemorrhage if they are accompanied by different complaints such as vomiting.

The baby’s tendency to sleep and waking up from sleep can be a sign of a brain hemorrhage.

Clear fluid or blood coming from the nose or ear may be a sign of a head injury and a cerebral hemorrhage may develop together.

Loss of balance or trouble walking can be a sign of cerebral hemorrhage, which should not be neglected.

Changes such as a decrease in activities and the child taking more time to rest are among the symptoms that should be considered, especially after head trauma.

Blurred, double vision, or sudden loss of vision

Weakness in arms and/or legs

epileptic seizures

Decreased interest in the environment, sucking or eating disorders in babies can also be symptoms of cerebral hemorrhage.

These symptoms can be caused by many different ailments. In order for the diagnosis to be made fully, it is necessary to consult a Brain, Nerve and Spinal Cord Surgery doctor without losing time.

WHAT ARE THE CAUSES OF BRAIN BLEEDING?

Brain hemorrhage is popularly known as a disease of older people. However, brain hemorrhage can be seen in every age group due to various reasons.

The causes of brain hemorrhage can be listed as follows;

Trauma
Head trauma from a fall, automobile accident, sports injury or other blow to the head is the most common cause of cerebral hemorrhage, especially in people under 50 years of age. It can cause all types of intracranial bleeding. Bleeding can also occur with the rupture of the vessels as a result of the rupture of the brain layers or the sudden displacement of the brain tissue due to being pushed inside the skull, whether there is a fracture in the skull or not.
Hypertension
Hypertension, or high blood pressure, can weaken blood vessel walls over time. Untreated high blood pressure is one of the leading causes of brain hemorrhages. Hypertension is also a preventable cause of cerebral hemorrhage.
Aneurysm
The word means vasodilation (bubble formation). As a rule, an aneurysm causes the vessel to expand as a result of the weakness in the vessel wall, and ruptures from the weak place with the effect of blood pressure, causing bleeding. Aneurysms can develop due to vessel wall weakness, as a result of traumas or due to different reasons such as fungal infections.
Vein ball disease (Blood vessel abnormalities -Arteriovenous malformations- AVM)
Weaknesses in the brain and surrounding blood vessels may be congenital but can be diagnosed if symptoms develop. With an unknown mechanism, the normal vascular structure deteriorates and a vascular bundle is formed. Thus, bleeding occurs as a result of rupture of an area in the vessel wall of the AVM that cannot withstand high blood pressure.
Atherosclerosis - hardening of the arteries
Atherosclerosis, popularly known as arteriosclerosis, is one of the most common diseases among cardiovascular diseases. Atherosclerosis, which is more common especially in people over the age of 45, is among the causes of heart attack and brain hemorrhage, which are not treated.
Glioma
Brain tumors that grow large enough to damage surrounding tissues can also cause brain hemorrhages.
Liver Diseases

Diseases affecting the liver can cause bleeding in different parts of the body and increase the risk of brain hemorrhage.

In addition, bleeding may occur after bleeding-coagulation diseases, use of anticoagulant drugs and a vascular disease called vasculitis.

HOW IS A BRAIN BLEEDING DIAGNOSED?

Thanks to the developing technology, brain hemorrhages can be diagnosed more easily than in the past. The person suspected of having a brain hemorrhage should be taken to a well-equipped hospital without wasting time. After the doctor’s examination, some radiological imaging can be used to clarify the diagnosis of cerebral hemorrhage.

HOW IS BRAIN BLEEDING DETECTED?

Computed Tomography (CT)
Magnetic Resonance (MR)

CT or MR imaging methods can provide extensive information about the location and characteristics of cerebral hemorrhage. If bleeding is seen in or around the brain, further testing may be needed to try to determine the cause of the bleeding. These additional tests can help determine if abnormal blood vessels are present, as well as the next step in diagnosis or treatment.
In some cases;

To examine the cerebrospinal fluid surrounding the brain, lumbar puncture can confirm cerebral hemorrhage.

Conventional angiography may be performed to identify an aneurysm or arteriovenous malformation.

HOW IS BRAIN BLEEDING TREATED?

Beyin kanamaları beynin içinde veya dışında olmasına bakılmaksızın her zaman doktor kontrolünde olmayı gerektiren ve bazen acil müdahale gerektiren durumlardır. Beyin kanaması sonrası kafatası içindeki basınç artığı için tüm beyin tehlike altındadır. Beyin kanamasında doğru tedavinin uygulanabilmesi için kanamanın yeri, beyin kanamasının neden kaynaklandığı ve kanamanın büyüklüğü belirlenmelidir. Zaman kaybetmeden uygulanacak tedavi kanamanın yaratacağı olumsuz etkileri azaltarak hastanın iyileşme şansını ve tedaviden sağlanan faydayı yükseltmektedir. Beyin kanamasından sonraki saatlerde kan basıncı yakından izlenmelidir. Beyin kanaması tedavisinde cerrahi yöntemler kullanılabildiği gibi beyin ödemine ve epileptik nöbetlerin giderilmesine yönelik ilaçlar da uygulanabilmektedir.

FREQUENTLY ASKED QUESTIONS ABOUT BRAIN BLEEDING

What are the types of brain hemorrhage?
Brain hemorrhages are generally divided into two classes.
Bleeding inside the skull but outside the brain tissue, and bleeding inside the brain tissue.
Bleeding inside the skull but outside the brain tissue
The brain has a layer of membrane that runs between the skull and brain tissue. This membrane layer surrounds and protects the brain. Bleeding in the skull between the skull and the meninges or between the brain and the cerebral cortex, usually due to head trauma, is called epidural and subdural hemorrhage, respectively. Subdural hemorrhages can be observed even in mild traumas in patients taking blood thinners.
Great vessels of the brain pass between the layers of the cerebral cortex, aneurysm hemorrhages usually occur between these meningeal layers, and in severe hemorrhages, blood disperses into the brain tissue. These bleedings usually tend to bleed again within the first day. Therefore, patients must be under medical observation and treated. In addition, in the first few days after hemorrhage, constriction of large vessels and decrease in cerebral blood supply and excessive accumulation of brain water in the brain are other undesirable conditions that need to be treated quickly.
Two types of cerebral hemorrhage can occur in the brain tissue itself. The first is bleeding into the brain tissue (intracerebral), the second is bleeding into the natural internal spaces of the brain (intraventicular).
Intracerebral hemorrhage It can occur anywhere in brain tissue such as the lobes of the brain, brain stem, spinal cord, and cerebellum.
Intraventricular hemorrhage: This bleeding occurs in the cerebral ventricles, which are the cavities of the brain where cerebrospinal fluid is produced.
What happens in the brain when there is a brain hemorrhage?
The brain obtains the oxygen and nutrients necessary for its own functions from the blood coming to the brain through the blood vessels. The brain itself cannot store oxygen and produce energy. When cerebral hemorrhage occurs, the necessary oxygen may not reach the brain tissues. The blood collected as a result of cerebral hemorrhage can also create pressure and leave the brain without oxygen. When the blood flow to the brain stops, after a certain period of time, brain cells begin to die. Nerve cells affected by a brain hemorrhage and the functions they control may also be damaged.
Is a brain hemorrhage fatal?
Cerebral hemorrhage can cause brain damage and death in patients. Consequences of brain hemorrhage;
  • – The area where the brain hemorrhage occurs inside the skull
  • – The size of the bleeding
  • – Time elapsed between cerebral hemorrhage and treatment
  • – It may differ according to the age and general health of the patient.
Brain cells do not regenerate after they die. Therefore, depending on the size of the bleeding and the time elapsed between treatment, the damage may be serious.
“How long does a patient with a brain hemorrhage live?”, “Will the patient with a brain hemorrhage recover?”, “Will the patient with a brain hemorrhage survive?”, “What is the death rate from a brain hemorrhage?”, “How many years do patients with a brain hemorrhage live? ”, “What are the chances of surviving a brain hemorrhage?”, “What is the chance of survival for those who have had a brain hemorrhage?”, “Does a brain hemorrhage kill a person?”, “What is the risk of death in a brain hemorrhage?”, “Does a brain hemorrhage cause permanent damage?” , “What are the consequences of brain hemorrhage?”. “What are the chances of survival after a brain hemorrhage?” Such questions are among the most frequently asked questions.
Although the risk of death in brain hemorrhages has decreased considerably in the last 30 years, scientific studies show that the risk of death is still high. Some of the patients may die before reaching the hospital after suffering a brain hemorrhage.
Damages that occur during brain hemorrhage can be permanent. The damage that occurs according to the cells that die in the brain during cerebral hemorrhage may also show differences.
How is brain hemorrhage surgery done?
Brain hemorrhage surgery may differ according to the cause of the bleeding, its size and the area where the bleeding occurs. Although not all brain hemorrhages require surgical intervention, brain hemorrhages usually require immediate medical attention.
Pressure on the brain can occur as a result of cerebral hemorrhage. If this pressure cannot be relieved despite the intervention with drugs, decompression can be performed. The purpose of the decompression procedure is to relieve the brain, which is compressed as a result of bleeding, and to evacuate the blood that causes pressure.
Decompression can be performed in different ways, depending on the cause and size of the bleeding.
With Open Surgery
Part of the skull is removed. Open surgery is performed to drain the hematoma, that is, the accumulation of bleeding in the tissue, and to repair the ruptured blood vessel. It is a major surgical procedure used in cases where the accumulation of blood in the tissue is too great or where the areas of the brain where important functions of the body are controlled are affected by pressure.
Simple aspiration
A small hole is made in the skull with a procedure similar to a biopsy. With the help of the catheter, the blood accumulated in the skull is drained. This method can be preferred in elderly patients whose general condition is very poor to avoid the risks of major surgery. In this method, the blood accumulated in the brain may not always be completely emptied, but the brain is relieved by reducing the pressure.
endoscopic evacuation
This process is similar to simple aspiration. A small hole is made in the skull, as in the simple aspiration procedure. With the help of an endoscope instead of traditional surgical instruments, the blood accumulated in the skull can be evacuated.
Stereotactic aspiration
Computed Tomography is used to find the hematoma, that is, the accumulated blood in the skull. It uses a specially developed suction device to drain the accumulated blood. During this procedure, the patient is immobilized in a stereotactic head frame that provides a high degree of sensitivity and accuracy.
Endovascular methods
The cause of brain hemorrhage can be caused by vascular problems such as aneurysm or AVM. In such cases, vascular disorders should be treated with surgery or endovascular methods. The basic technique of intravascular (endovascular) cerebrovascular surgery is high-tech angiography. The procedure, which should be performed by experienced physicians, is generally performed by placing very thin and special tubes into the vein in the groin area, and reaching the sick vein through the vein. All stages of diagnosis and treatment are observed live on the device screen. By endovascular method; It is possible to treat many ailments such as brain hemorrhages due to aneurysm and vascular lump, intervention to aneurysm and AVM that have not yet bled, fistula and stroke. This method is preferred in patients who do not require open surgery, that is, in patients whose brain pressure is not high due to bleeding.
If the brain tissue is under severe pressure and there is a pushing effect towards hard areas, open surgeries should be preferred over other methods.
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