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Cerebral Hemorrhage

Cerebral hemorrhages are due to rupture of an artery, usually a small one, as a result of various disease processes (see below). Cerebral hemorrhage affects almost 40,000 people in the United States every year, and carries a mortality rate of 40% and a disability rate of 40%. Thus, only 20% of patients who have a cerebral hemorrhage are alive and independent 1 year after a cerebral hemorrhage. Risk factors for cerebral hemorrhage include age (increases with increasing age), race (more prevalent in African-Americans), and history of hypertension. Prognostic factors include volume of hemorrhage, extension of hemorrhage into the ventricles (water drainage system of the central nervous system), and level of consciousness at the time of the event (comatose patients have a worse prognosis).

Symptoms of cerebral hemorrhage vary depending on the location of the hemorrhage, but can include paralysis, sensory loss, visual loss, difficulty vocalizing, confusion, incoordination, imbalance, double vision, nausea and vomiting. Head pain at the onset of symptoms, in combination with the above symptoms, is particularly characteristic of cerebral hemorrhage. In the presence of any of these symptoms, emergency medical care is needed, and a person must be immediately taken to a hospital equipped for dealing with serious central nervous system problems. Routine investigations for diagnosing cerebral hemorrhage include CT scan or MRI. CT scan is quicker and allows for more rapid initiation of treatment, whereas MRI can also detect evidence of any past hemorrhages that may have gone undetected. CT scan with contrast or MRI with contrast can aid in detecting any underlying abnormalities that may have caused the hemorrhage (see below).

Despite multiple studies assessing treatment strategies for cerebral hemorrhage, no single treatment modality has proven to be the best, and management is largely based on the clinical judgment of the neurologist and neurosurgeon involved. Current treatment options include surgical evacuation of the hematoma, insertion of a drain to remove backed up cerebrospinal fluid that can lead to increased pressure within the skull, or medications that can reduce the swelling around the hematoma and thereby also decrease the intracranial pressure (mannitol or glycerol). Treatment is often individualized based on the patient's age and clinical status, size and location of hemorrhage, duration of symptoms, and family wishes with regard to end of life decisions.