Cerebral hemorrhage also known as stroke is associated with ischemic conditions. These types of conditions often occur when the brain experiences shortage of blood supply. The brain cells get damaged as a result of bleeding internally. There are several types of cerebral hemorrhage caused in different regions of the brain. The most predominant type of cerebral hemorrhages include:
Intra cerebral hemorrhages: In this condition the brain experiences internal bleeding and it occurs in the region of the cerebellum depending upon the zone of injury that leads to the bleeding. The parenchymal tissues of the brain undergo severe damage in this condition.
Subarachnoid hemorrhages: This type of bleeding is caused between the membranes lining the brain.
Subdural hematoma: This is commonly found in athletes such as boxers and wrestlers. The injury or trauma is caused to the veins underneath the dura of the brain.
Epidural hematoma: This is also a condition caused because of trauma or head injury. The meningeal artery is ruptured leading to bleeding in the region between skull and membrane covering the brain.
Other forms of damage caused to the brain predominantly include ventricular damage which is caused because of trauma to the ventricles of the brain which contain the cerebrospinal fluid.
Causes of stroke
Cerebral hemorrhage or stroke may occur because of many reasons. In most forms it is closely associated with congenital abnormalities of the brain and also because of trauma or altered lifestyle patterns. Some of the common conditions that cause cerebral hemorrhages are aneurysms; deformities in the arterial and venous supply to the brain, presence of abnormal proteins such amyloids which lead to deterioration of brain cells and hypertension.
The major risk factors for cerebral hemorrhage are hypertension, trauma and alcoholism. This condition mostly occurs in patients who have a history of diabetes, habits such as alcoholism, smoking and aged people. Many patients experience numbness in their hands, legs, blurred vision, headaches, confusion and also impaired speech patterns because of hypertension associated cerebral hemorrhage. The damage is caused predominantly in the ventricular region of the brain.
The symptoms associated with cerebral hemorrhage often lead to paralysis, seizures and sudden loss of consciousness, tingling sensation in the feet, altered taste patterns, nausea and inability to swallow. This happens because of ischemia or lack of blood supply to the brain which inevitably affects the neuromuscular activity of the body. In addition to these, cerebral hemorrhage also results due to liver damage or brain tumor.
In case of head injury or trauma, the hematomas have to be removed as soon as possible with thorough evaluation of the damaged regions of the skull in association with the membranes to rule out all possibilities of internal organ bleeding or presence of any kind of blood clots. Patients are rushed in for radiological examinations to minimize the time required to intervene the situation of head injury as any delay can be fatal. In patients with hypertension and previous history of diabetes, thorough radiological examination is performed to identify the ischemic regions present in the brain. Abnormal blood vessels are corrected using interventional radiology.
Treatment options for cerebral hemorrhages are often associated with treatments pertaining to hypertension and diabetes. Patients are counseled to undergo corrective surgeries in case of hemorrhages associated with aneurysms.
Lumbar puncture, also known as the spinal tap is an invasive diagnostic procedure carried out to collect a sample of cerebrospinal fluid. The fluid is collected for cytological, microbiological or biochemical investigation or at times to relieve the excess pressure in the cerebrospinal fluid pressure. This test is used to make a diagnosis or rule out primary or metastatic brain or spinal cord neoplasm, meningitis, encephalitis, autoimmune diseases of the central nervous system or cerebral hemorrhage.
The patient is requested to lie in the lateral position (on his/her side) on the bed to prepare for a lumbar puncture. The patient is made to lie perpendicular to the bed in a fetal position. A spinal needle is inserted either between the L3/L4 or L4/L5 and is pushed till the needle goes past the dura mater. The cerebrospinal fluid is then collected by removing the stylet from the spinal needle. The pressure of the cerebrospinal fluid is measured before and after extracting the sample. The entire lumbar puncture procedure takes about 20 minutes.
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Bibliography / Reference
Collection of Pages - Last revised Date: December 1, 2021