Introduction
Brain hemorrhage is a condition in which a bleeding takes place within the skull due to various reasons. The amount of bleeding can differ depending on the underlying cause and its manifestations would be dependent upon the site of bleeding, amount of bleeding, interventions made as well as due to other co-morbid factors. In any event, there is an element of uncertainty about the recovery of such patients as the highly sensitive nature of the brain cells and the amount of exact damage is difficult to assess with the technology that we possess.
Diagnosis
When considering treatment options, the site of bleeding would be highly important. In order to assess this, the clinicians will be making use of various diagnostic methods and CT and MRI would probably be the most sought after investigations in such a situation. These imaging studies will give an exact location of the bleeding and the extent of the hemorrhage.
By assessing the clinical findings, clinicians will be able to predict the progression of the hemorrhagic event and take measures to prevent further complications. Thus, looking at the optic disk through the eye and analyzing other clinical presentations such as headache, nausea, vomiting, consciousness, blood pressure, pupil reaction to light and its size and vision disturbances would give a picture that would be useful in managing it.
Treatment
Based on the above assessment, the treatment would focus on several key elements. Among them, the main element would be to prevent life threatening complications such as herniation of brain stem due to shift in the brain position as the hematoma or a swelling pushes against the brain matter. Thus, in simple terms, the focus would be on reducing the intra-cranial pressure building up because of hematoma formation, as well as due to inflammatory swelling of the brain matter.
Secondly, the clinicians would be aiming to maintain the vital functions such as respiration, heart beat…etc through means such as artificial ventilation and drugs.
Thirdly, they would be looking at long term recovery as following such hemorrhage, the damaged brain cells either won’t revive or, else the other cells would take a long time to adapt themselves in gaining adequate functionality.
Accordingly, different methods can be used to relieve intra-cranial pressure and among them, burr hole surgery, craniotomy, medications such as diuretics, corticosteroids…etc would play a major role. Apart from these, such patients would benefit in taking painkillers as well as anticonvulsive medications to prevent any fits from developing.
During this time, these patients would also benefit from taking intravenous fluids as well as intravenous or NG feeds to maintain nutrition if the hemorrhage had left the patient unable to swallow without being aspirated.
The long term management would most likely to involve a team of professionals and among them the physiotherapist, speech therapists and the occupational therapists would play a vital role in getting these patients back to normalcy, in the case that the hemorrhage had left a persistent effect over certain body structures.
