Brain Hemorrhage - Medical Malpractice Lawyers – Compensation Claims
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A brain hemorrhage includes any kind of bleeding in or around the brain. There are multiple causes of brain bleeding, including trauma, high blood pressure, drug abuse, weak blood vessels and aneurysms. People with brain hemorrhages can have a severe headache or can have symptoms similar to a stroke. They can have weakness on one side of the body, a sensation of numbness or difficulty speaking. They can have problems with usual daily activities. They may fall. In fact, about 10 percent of all strokes are hemorrhagic or the result of bleeding into the brain.
There are many different ways to classify brain hemorrhages. For example, bleeding anywhere inside the skull is termed an intracranial hemorrhage. Bleeding inside the brain itself is called an intracerebral hemorrhage. There can be bleeding between the brain and the covering outside the brain, called a subarachnoid hemorrhage. Blood clots between the skull and the brain are either an epidural or subdural hemorrhages, depending on whether the blood clot is above or below the dura of the brain. These two hemorrhages are more likely to be occurring with a trauma to the brain.
When bleeding occurs within the brain itself, there may be no headache because the brain doesn’t have the pain sensors to know that something serious is going on. The meninges or covering of the brain, however, is very sensitive and if any blood occurs on the meninges, there will be a sudden and severe headache.
The most common cause of a hemorrhage in the brain is high blood pressure. Over time, the high blood pressure can weaken the arterial walls so that they rupture. When this happens, there are often signs and symptoms of a stroke. Another cause of a brain hemorrhage is an aneurysm, where there is a weak place in an artery. The artery balloons out and eventually ruptures. Arteriovenous malformations are unusual connections between veins and arteries that are present from birth. They can bleed later in life, causing a brain hemorrhage. People with metastatic cancer can have brain metastases that bleed. People who use drugs like cocaine can develop weak blood vessel that can lead to hemorrhaging in the brain. Certain prescription drugs like blood thinners can lead to bleeding within the brain.
Headache may or may not be a major symptom of brain hemorrhage. It depends on where the bleeding is present. If the bleeding is associated with the visual part of the brain, there may be loss of vision. In different parts of the brain, there are balance and coordination problems, weakness on one side of the body, numbness or even a sudden seizure. Speech may be disrupted if the bleeding is on the left side of the body. If the bleeding is in or near the brainstem, the patient may go into a sudden coma and may die because the respiratory centers of the brain are affected.
If a stroke or bleed is suspected, the patient needs to be immediately evaluated. Doctors may note slurred speech, weakness or loss of bodily sensations. Usually a CT scan or MRI scan is immediately ordered, which will show the blood in the brain. They will show the features of the brain and hint at increased intracranial pressure. An angiogram may be ordered which will show which blood vessel is bleeding and will help surgeons determine the course of therapy. A spinal tap will show that bleeding is happening inside the brain and is a very sensitive when it comes to detecting bleeding in the brain.
The treatment of bleeds in the brain begins with very close monitoring. Early treatment includes making sure the blood pressure is stable and that the patient is breathing appropriately. Sometimes the patient needs to be assisted in the area of breathing with a ventilator. The patient requires IV access to make sure that medications and fluids can be given to the patient, particularly if the patient is unconscious and can’t take medications in any other way. There needs to be careful monitory of the patient’s heart rhythm, oxygen levels in the blood and pressure within the brain if this is necessary.
When the patient is medically stable, doctors then decide how to tackle the problem of bleeding. Sometimes this is a rapid process and other times the doctor has some time to think about whether surgery is necessary or whether the bleeding will stop one its own. It depends on the location and size of the bleed. Small bleeds are less likely to need surgery than large bleeds.
Medications can be used to decrease the swelling in the area of the bleed. Mannitol is sometimes prescribed to decrease overall intracranial pressure. Medications that keep the blood pressure very low can often help slow or stop the bleeding.
Most people who have had a brain hemorrhage actually survive. The survival rate, however, is decreased when the bleeding occurs in critical areas of the brain or if the hemorrhage the patient has is very large. In fact, the risk of dying secondary to an intracerebral hemorrhage is over forty percent. If the intracerebral hemorrhage occurs at or near the brainstem, the risk of death is as high as 75 percent.
Even if the patient survives the initial intracerebral hemorrhage event, their recovery can be months or even years. The patient will need physical therapy for strengthening, occupational therapy to learn activities of daily living, and speech therapy to learn how to swallow and speak as normally as is possible. Some patients have ongoing seizures, while others have chronic headaches or memory deficits.
In special situations, infants born at less than 32 weeks gestation are at a greater risk of developing bleeding because their blood vessels are immature. Approximately ten percent to fifteen percent of preterm infants will develop some kind of intracranial hemorrhage. The hemorrhage can lead to hydrocephalus, which is an enlargement of the fluid filled spaces in the brain. This can encroach on real brain tissue and can cause brain damage. If delivery absolutely cannot be delayed, certain medications can be given to the mother in order to prevent this from happening.
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