|
Hypertensive intracerebral hemorrhage Causes and Risks:
Intracerebral hemorrhage (from any cause) occurs in about 2 out of 1,000 people. It can affect any person regardless of age, sex, or race but is most common in older individuals.
Hypertensive intracerebral hemorrhage is caused by the effects of high blood pressure . When the blood pressure is chronically high, the blood vessels may develop small weakened areas
(microaneurysms) from the constant pressure on the vessel walls. These microaneurysms can leak blood into the tissues. Intracerebral bleeding associated with hypertension most commonly occurs in the tissues of the basal ganglia but may occur in any part of the brain. Blood irritates the brain tissues, causing swelling (cerebral edema). The blood collects into a mass
(hematoma). Both swelling of the brain tissues and the presence of a hematoma within the brain put increasing pressure on the brain tissues and eventually destroys them. Bleeding may occur into the ventricles of the brain or into the subarachnoid space (the space between the brain and the membranes covering the brain), causing symptoms of meningeal irritation.
Symptoms vary depending on the extent of damage and the location of the bleed. Symptoms most commonly develop suddenly, without warning, often during activity. They may occasionally develop in a stepwise, episodic manner or in a progressive manner.
Prevention:
Treatment and control of causative and risk-related disorders may reduce the risk of developing intracerebral hemorrhage . High blood pressure should be treated as appropriate; do not stop taking medications unless advised to do so by the health care provider.
Symptoms:
Signs and Tests:
Neuromuscular examination may indicate increased intracerebral pressure and localized decreases in brain function. The specific pattern of function changes may indicate the location of the intracerebral hemorrhage . Eye examination may show swelling of the optic nerve associated with increased pressure within the brain, or there may be changes in eye movement. Abnormal reflexes may be present, or there may be an abnormal extent of normal reflexes. The blood pressure is usually high.
Tests to determine the amount and cause of bleeding include: Intracerebral hemorrhage can be confirmed, and the location and amount of bleeding determined, by:
Treatment:
Treatment goals include lifesaving interventions and life support measures, supportive measures, and control of symptoms.
Surgical removal of the hematoma may be appropriate, especially if there is a hematoma in the base of the brain (cerebellum). Surgical placement of a shunt to drain the area may be recommended in some cases.
Medications include antihypertensive medications to control blood pressure ; corticosteroids such as hydrocortisone, or diuretics, to reduce brain swelling ; anticonvulsants to control seizures ; and analgesics to control pain.
Prognosis:
The probable outcome is highly variable and depends on the size and location of the bleed. Recovery can occur completely or with any level of permanent loss of brain function. Medications, surgery, and treatments can have severe side effects. Death can occur rapidly despite prompt medical attention.
Complications:
- permanent loss of any brain function
- side effects of medications and treatments
- complications of surgery
Call Your Healthcare Provider:
Intracerebral hemorrhage is a severe condition requiring immediate medical attention. It can develop quickly into a life-threatening situation!
Go to the emergency room or call the local emergency number (such as 911) if symptoms of hypertensive intracerebral hemorrhage occur. Emergency symptoms include difficulty breathing , seizures , loss of consciousness , inability to speak , and swallowing difficulties .
|
