Intracranial hemorrhages have traumatic etiologies they are secondary to impacts, crashes and accidents or they may associated with other medical conditions
Intracranial hemorrhages are medical conditions, which threat life and are characterized with sudden onset and disabling outcomes. This condition is among common underlying causes, along with myocardial infarction, of unexpected and sudden death. The medicine is no more totally desperate for management of intracranial hemorrhages, which is publicly regarded as a condition, which is associated with poor outcomes and leads to disabling sequel.
Intracranial hemorrhages have traumatic etiologies, or in other words, they are secondary to impacts, crashes and accidents or they may associated with other medical conditions, including but not limited to hypertension and aneurysm, while hemorrhage can be an isolated spontaneous event. Post-traumatic intracranial hemorrhages have different clinical pictures, while severity may vary and they occur at different localizations. Post-traumatic intracranial hemorrhage may be in the form of contusion – bruising-like bleeding foci, while bleeding into the space between brain and the dura mater is referred as subdural hematoma and epidural hematoma implies the bleeding into the space between the skull and the dura mater. Bleeding is stopped and hematoma is aspirated with surgical intervention for some hemorrhages, while medication therapy and critical care will be also sufficient for some patients.
Hypertension is one common etiology of intracranial hemorrhages. Risk of hypertension-induced bleeding is high for patients, who has hypertensive course for a long time, does not use medicaments regularly, does not follow nutritional and dietary instructions and have comorbidities – especially ones impairing vascular integrity. There are two types of hypertension-induced intracranial hemorrhages: Ones secondary to rupture of capillary at deep localization of brain and major bleeding into cerebral tissue, resulting with hematoma. Surgery is necessary for intracranial hemorrhage, which leads to increased intracranial pressure and is severe enough to skip medical treatment.
Blood flows through a defect on the wall of cerebral vessels and thus, the blood dissects and separates layers of the wall. The result will be a weak vascular wall, which appears like a blood-filled balloon-like bulge on external surface of the vessel. This weak wall may rupture and progress into “subarachnoid hemorrhage”, for which time of bleeding cannot be predicted. This condition is characterized with blood leak between cerebral sulci and symptoms include severe headache, vomiting and confusion. Active bleeding poses high risk of death. Management of this condition is really challenging and associated with many variables.
Diagnostic cranial angiography is performed for patients, if aneurysmatic hemorrhage is considered. Management is based on location and size of the aneurysm and the extent of involving surrounding tissues. Other problems we should overcome include vasospasm (implies shrinkage of vessels), hydrocephalus (abnormal fluid collection in brain tissues secondary to adhesions) and recurrent hemorrhage.
Early surgical occlusion of aneurysm is recommended for patients with post-hemorrhagic good overall condition or embolization is required for eligible patients. The surgery is a challenging one and it is undoubtedly posing some risks. However, very successful outcomes can be obtained at our country, when equipment is sufficient and surgery is carried out by an experienced team.
Aneurysms of cerebral vessels are colloquially referred as “balloon of vessel”. Although this metaphor is very valid for the shape of the condition, outcome of the condition is unfortunately very poor for most patients.