Sabtu, 30 Maret 2013

Intracerebral hemorrhage: Bleeding within the brain

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All strokes damage the brain by stopping the circulation, but strokes are available in many varieties. Because different parts of the brain are specialized to perform specific functions, whether products symptoms vary depending on which part of the brain was injured. The symptom In one patient may have weakness on one side of the body. Another might be a partial loss of sight. In yet another, a loss of speech. And the symptoms can vary in intensity from mild to severe depending on how big is the area of damage and if it occurred in a crucial position.

Strokes can also vary according to another key difference-if they involve a blocked blood vessel or bleeding. Most strokes are caused by previous in which brain tissue damaged by lack of movement is called a heart attack. But 10-15% of strokes involve bleeding from ruptured blood vessels within the brain tissue, and while it’s pretty bad to have a stroke, hemorrhagic stroke (intracerebral hemorrhage) can be even more devastating.

A leading figure with spontaneous intracerebral hemorrhage is Ariel Sharon, including hemorrhagic stroke occurred while he was still Prime Minister of Israel. Although some patients with intracerebral hemorrhage recovery from a point of being able to enjoy other people and regain some independence in operation, poor clinical outcome of Sharon is all too common in patients with this disease.

The additional problem with hemorrhagic stroke is that new blood deposit takes up space-sometimes a lot of it-and there’s only so much space inside the skull (Cranium) to go around. The cool crazy bleeding and distorts the brain tissue next to it, and also subject the rest of the brain for increased pressures that may be harmful. Because of these distortions and variations in pressure, a patient with intracerebral haemorrhage often shows a decreased level of consciousness or even coma.

Another type of spontaneous bleeding within the skull is SAH, often caused by rupture of brain aneurysms outside, but inside the cranium. While this, too, is a very serious condition, it is not the focus of this particular essay and spontaneous intracerebral hemorrhage caused by aneurysms are not of this type. Yet another type of bleeding that may be confused with intracerebral hemorrhage (primary) is secondary hemorrhage. This occurs in some patients who started with brain infarcts, but who had later bleeding from fragile blood vessels around the edges of a heart attack. This type of bleeding is not quite as serious as the one that occurs when the bleed is primary (the initial one).

How are diagnosed intracerebral hemorrhage? Since the 1970s when they were introduced computed tomographic (CT) scans, this imaging technique was the most effective and sensitive. A fresh bleeding within the brain tissue is dramatically apparent on CT scans. And unlike heart attacks that can take a day or two to show up on CT scans, hemorrhages are already visible at the earliest time that can be carried out a scan.

Although surgical removal of blood clots from the brain surface-hematoma subdural and epidural called-can be life-saving and function-sparing, surgery for a bleeding (hematoma or blood clot) within the brain tissue itself is another story. Some studies comparing the results between operated and non-operated patients with intracerebral hemorrhage shown better result, on average, patients operated, while still others have shown results worsened. Patients operated or not operated, had high rates of death and disability.

Because of the limited prospects for significant improvement, surgery for intracerebral hemorrhage is often an act of desperation. A crusty old clinician was outspoken about the dramatic situation, saying: “show me a patient with intracerebral haemorrhage whose life was saved by surgery, and I’ll show you a patient wishes that he hadn’t acted on”. His point was that the survivors of this operation usually show serious impairments.

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