Cerebral hemorrhage results when a blood vessel in the brain bursts, bleeding into and destroying the surrounding brain cells. The clinical picture produced is called a stroke or apoplexy; it varies widely, depending upon the position and extent of brain damage produced by the bleeding. The effect of cerebral hemorrhage is to cut off the blood flow to the part of the brain beyond the break with consequent death of its cells. If bleeding continues, the damaged area will extend. The pressure of continuous bleeding will also affect other healthy parts of the brain, because it is a soft structure within the rigid box of the skull. The predisposing causes of cerebral hemorrhage are arteriosclerosis or aneurysms of the brain arteries, hypertension, heart disease, embolism and brain tumors. Anything that causes a sudden rise of pressure in the blood vessels; e.g. coughing, spasms, straining or severe exertion may precipitate the cerebral hemorrhage, in the presence of damaged blood vessels.
The usual manifestations of cerebral hemorrhage are a sudden impairment in the level of consciousness, an alteration in the breathing pattern and paralysis with or without loss of sensation in one or both sides of the body, depending upon the site of the hemorrhage. In very mild cases the paralysis may be limited or even transient, without loss of consciousness. These cases may be due to a spasm of the brain blood vessels, not a hemorrhage. In very severe cases, the patient may go into a deep coma and may eventually die.
The after-effects of cerebral hemorrhage depend on the amount of brain damage and vary from almost complete recovery to varying degrees of residual paralysis. Mental confusion may persist in severe cases. Treatment is primarily conservative and is directed towards limiting the extent of the immediate catastrophe. The patient should be laid flat on his side to prevent his swallowing his tongue or inhaling vomit. False teeth should be removed, the clothing loosened and cold applications placed on the head. As soon as recovery from the immediate effect of the cerebral hemorrhage has occurred, treatment consists in the rehabilitation of the patient to as near normal life as possible, including physiotherapy with re-education in the use of paralyzed muscles, thus preventing chronic contrac-tures in those irrevocably paralyzed, and encouraging the use of the mental faculties.
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