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best-neurologist-in-gurgaon-blog · 6 years

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Brain Hemorrhage Treatment In Gurgaon

The facts:

A brain bleed or brain hemorrhage as it is called is bleeding in or around the brain. It can occur spontaneously as a large hemorrhage, with sudden onset catastrophic symptoms or it can occur gradually where it bleeds slowly over a period of time, with no apparent symptoms at all. It is said that almost 13% of strokes are caused because of hemorrhagic causes. It can be Traumatic or Spontaneous.

Why do they have different names?

These hemorrhages are given different names based on the exact location inside the skull where the bleeding occurs. Bleeding anywhere inside the cranial cavity is known as intracranial hemorrhage. Whereas bleeding into and within the brain tissue itself is called an intra-cerebral hemorrhage. But between the skull and the brain matter, you have what is the lining of the brain, made of three layers called the Dura mater, which is closest to the skull, Arachnoid mater, which lies in the middle and Pia mater, which is closest to the brain tissue. Bleeding can occur anywhere in between these layers as well.

Broadly they can be Traumatic or Non Traumatic.

These different types of hemorrhages are:

Extradural/epidural hemorrhage – which is bleeding between the skull and the Dura mater, which is commonly caused by trauma due to acceleration-deceleration forces and rupture of the meningeal vessels.

Subdural hemorrhage – which is bleeding between the Dura mater and Arachnoid mater. These hemorrhages are also again caused by trauma, but it is the subdural hemorrhages that most often tend to be chronic and innocuous as well.

Subarachnoid hemorrhage – is bleeding between the Arachnoid mater and the Pia mater. This type of bleeding is commonly caused by the rupture of an aneurysm.

NonTraumatic Basal Ganglia ICH (Most Common ICH encountered in Clinical practice), Thalamic ICH, Spontaneous Cerebellar Hematomas.

What are the signs to look out for to suspect an ICH?

The common symptoms which patients experience when they develop and ICH include:

Sudden onset severe headache

Any changes which follow trauma to the head should warn you about the development of an ICH

Neck stiffness

Nausea and vomiting

Altered levels of consciousness/loss of consciousness

Development of seizures

Neurological deficits such as numbness, weakness and impairment of vision and speech

In children you must suspect and ICH when the child presents with vomiting, seizures, loss of consciousness, swelling in the head or retinal hemorrhages. On most occasions the trauma which causes these types of injuries in children is due to child abuse.

How is an ICH diagnosed?

The most common investigation used to confirm the diagnosis of an ICH is the CT scan, because it is widely available. But where facilities are available an MRI scan is also equally useful for confirmation. A Magnetic Resonance Angiogram, if available will help to get an idea about the underlying cause of the ICH.

What are the treatment options available for intracranial hemorrhages?

There are different ways in which intracranial hemorrhages are managed depending on the exact location of the bleeding and the amount of bleeding which has occurred. The symptoms which the patient presents with also plays a role in determining the treatment plan. The various methods available for the management of an intracranial hemorrhage include non-surgical methods and surgical methods.

Surgical methods are required if the bleeding is extensive, which is determined by imaging techniques such as CT and MRI, or if the patient is displaying symptoms which are life threatening such as development of seizures and altered level of consciousness, all which occur due to increased intracranial pressure.

Non-surgical methods are used when the bleeding is minimal and the patient is asymptomatic. Your doctor will continue to monitor you, looking out for signs of increased intracranial pressure, and in the meantime you will be prescribed some medication such as anti-anxiety medication as well as drugs to prevent the development of seizures, and even pain relief medication, because some patient may only complain of a mild headache. Medication to reduce the swelling of the brain such as steroids as well as medication to bring down your blood pressure may be helpful in the management of an ICH.

What is the role of urgent surgery in intracranial hemorrhages?

Urgent surgery is most often required in the case of ruptured aneurysms which can cause subarachnoid hemorrhages or intra-cerebral hemorrhages. When it comes to intracerebral hemorrhages more often than not, your doctor will opt for immediate surgery because the brain matter can be extensively damaged if not intervened at the earliest, because of the increased intracranial pressure, leading to poor prognosis. Therefore the goal of urgent surgery is to save as much of the brain tissue as possible. The surgical options available are:

Decompression surgery using one of the four methods mentioned below:

Craniotomy – where the surgeon will make and incision in the scalp, remove a part of the skull, and drain the hematoma which has formed and repair the ruptured blood vessel. This is high risk surgery and is only performed when the bleeding is extensive, or when higher functions have been impaired in the patient.

Burr holeaspiration – where a small hole is drilled into your skull, through which a needle is inserted, and the hematoma is drained out. But for this you need to be able to identify the exact location of the hemorrhage, and it might turn out that the surgeon cannot completely drain the hematoma as well.

Endoscopic evacuation – which is similar to aspiration, but it involves the use of an endoscope which has camera and special equipment fitted at one end, and helps the surgeon visualize the insides of the cranial cavity.

During these procedures as well as due to the hemorrhage itself there is an increased risk the brain swelling up (cerebral edema). Therefore when the surgeon removes a part of the skull during a craniotomy, they may decide to replace it after some time, to allow for the contents of the cranial cavity to expand, while the swelling is still present. And once the edema is settled the part of the skull is replaced. This is known as a craniectomy. There are other methods which been used in order to tackle this problem of cerebral edema due to hemorrhage and surgery, which includes:

Duraplasty – which is a procedure used during the Chiari decompression surgery, where an incision is made in the Dura mater, and an extra patch is sewn in place in order to expand the surface of the Dura, to allow for the edema.

Cisternostomy – is a procedure where the basal cisterns are opened up to atmospheric pressure, in order to relieve the increased intracranial pressure which occurs as a result of cerebral edema. It is a novel technique which has replaced the older procedure of decompressive hemicraniectomy.

Brain hemorrhages can be a life threatening condition if not managed appropriately at the right time. But with the advent of newer and technologically advanced surgical methods, the success rate of surgical management is on the rise.

What precautions can I take to prevent the development of an ICH?

There is no specific method which can ensure that you prevent the development of an ICH. The main factor is to prevent trauma to the head as much as possible even when accidents do happen. Therefore taking the below mentioned precautions may help:

Wearing helmets when traveling on bikes, motorbikes, scooters and skateboards

Wearing your seatbelt when travelling in vehicles

Trying to prevent falls in an elderly

Non Traumatic ICH can be prevented by control of Blood pressure, regular check up from Neurologist/ Neurosurgeon and Diagnostic Angiograms.

What outcome can I expect following an ICH?

As an ICH is life threatening condition, the sooner it is treated the better the prognosis. But the overall outcome is dependent on the site where the bleeding occurs and how severe the bleeding was. Some patients may recover completely following management of the ICH, while some others may need rehabilitation such as speech therapy, physiotherapy and occupational therapy to help them perform their daily activities, if they have to overcome remaining neurological deficits.

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best-neurologist-in-gurgaon-blog · 5 years

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The patients having symptoms of a brain aneurysm should consult with Neurosurgeon in Faridabad

The brain contains a large number of blood vessels for transporting important chemicals in and out of the brain. In normal cases, these vessels are smooth without any structural abnormality. However, in some cases, these vessels form a bulb or balloon. This condition is known as a brain aneurysm. These balloons may rupture and cause a brain hemorrhage. The patients having symptoms of a brain aneurysm should consult with Neurosurgeon in Faridabad.

What Is Brain Aneurysm?

A brain aneurysm is a condition characterized by bulging or ballooning of blood vessels of the brain. There is a weak area in the blood vessel of the brain. This area, due to the constant flow of blood, worn out and bulges in the form of a hanging berry. As the blood vessel is weak from that position, it carries the risk of getting ruptured.

There are two types of brain aneurysms.

Saccular aneurysms: This is the most common type of brain aneurysm. These aneurysms comprise of a neck and a dome. Aneurism is connected to the parent vessel through the neck.

Fusiform aneurysm: This is a less common type of brain aneurysm. These aneurysms do not have definite neck and are widened from both sides of the arteries.

What Is The Cause Of Brain Aneurysm?

Although the exact cause of brain aneurysm remains unknown, it is believed that aneurysm may be caused due to following reasons:

Marfan’s syndrome: Formation of the connective tissue in the body is controlled by various genes. Any alteration in the functioning of these genes may result in weak arteries, not only in the brain but in other parts of the body. Marfan’s syndrome, which is a genetic condition, affects such genes.

Brain Injury: Brain aneurysm may also be caused by brain injury. The traumatic brain injury causes tear in the brain tissues which may also lead to a brain aneurysm.

Autosomal dominant polycystic kidney disease: This condition primarily affects the kidney and have an impact on the brain. While it causes cysts in the brain tissue, it also weakens the vessels.

Miscellaneous: Various other probable causative factor includes smoking, serious infection and chronic hypertensive condition.

What Are The Symptoms Of Brain Aneurysm?

In many cases, patients suffering from brain aneurysm do not experience any symptoms. The symptoms related to unruptured brain aneurysm include:

Dizziness

Seizures

Blurred vision

Vision changes

Mild to severe headache

A ruptured brain aneurysm may have the following symptoms:

Nausea and vomiting

Lack of consciousness

Neck stiffness

Increased sensitivity to light

Difficulty walking and speaking

Sudden and severe headache.

Immediate medical intervention is required in patients with the symptoms of a ruptured aneurysm.

What Are The Risk Factors For Developing Brain Aneurysm?

Following are some factor that increases the risk of developing brain aneurysm:

Age: Old age people are at higher risk of developing a brain aneurysm.

High blood pressure: Because of the constant blood flow through blood vessels, the vessels become weak or worn out leading to a brain aneurysm.

Cigarette smoking: Cigarette smoking significantly increases the risk of a brain aneurysm because smoking weakens the blood vessel which may result in bulging.

Alcohol consumption: Alcohol consumption and its intensity also influence the development of brain aneurysms.

Factors present by birth: Various congenital conditions may result in an increased risk of developing a brain aneurysm. These include Polycystic kidney disease, Cerebral arteriovenous malformation, Inherited connective tissue disorders, Abnormally narrow aorta, and Family history of a brain aneurysm.

How The Diagnosis Of Brain Aneurysm Is Done?

In many cases, brain aneurysm doe not show the symptoms and the condition is diagnosed while diagnosis other ailments. Following are some of the diagnostic techniques for diagnosing brain aneurysm:

Imaging technique: Various imaging techniques such as MRI are employed to diagnose the disease. MRI angiography identifies the presence of an aneurysm.

Cerebrospinal fluid test: The cerebrospinal fluid test may indicate the presence of blood cells in the region between the brain and thin tissue covering, the area known as subarachnoid space.

Cerebral angiogram: Cerebral angiogram is the procedure in which a flexible tube has inserted the artery and it travels through the vessels in the brain. The results are drawn with the help of X-ray images obtained through the procedure.

What Is The Best Treatment Of Brain Aneurysm?

Following are the treatment options for brain aneurysm:

Endovascular coiling: It is a less invasive procedure in which a soft wire is transported to the aneurysm and the wire coils up inside the aneurysm.

Surgical clipping: Through brain surgery, the blood flow to the aneurysm is stopped.

Management of symptoms and reduction of risk: Various drugs are used for these purposes such as Anti-seizure medications, analgesics or pain relievers and calcium channel blockers.

Lifestyle changes: Healthy eating, doing routine exercise and staying away from recreational drugs, smoking and alcohol also helps to manage the symptoms of a brain aneurysm.

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