Thursday, May 12, 2022

What Are The Chances Of A Second Brain Hemorrhage

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Initial Evaluation And Clinical Stabilization

Brain Hemorrhage HEALING – The Doctors Said it was Impossible!

According to the AHA/ASA guidelines and the Emergency Neurological Life Support protocols , spontaneous intracranial hemorrhage is a medical emergency and should be managed accordingly. The initial management should focus on the following principles :

  • 1.

    ABCs. Initial assessment and stabilization of airway patency, breathing, and circulation.

  • 2.

    Neuroimaging. Once clinical stability is achieved, an urgent imaging study for rapid and accurate diagnosis should be performed.

  • 3.

    Standardized neurologic assessment to determine baseline severity. The National Institutes of Health Stroke Scale , if the patient is awake or drowsy, or the Glasgow Coma Scale , if the patient is obtunded or comatose, should be performed and clearly documented.

  • 4.

    Blood pressure management, reversal of coagulopathy, and evaluation of the need for early surgical intervention.

  • 5.

    Frequent neurological examinations, at least every hour , to detect early clinical deterioration and signs of increased intracranial pressure should be part of the routine initial management algorithm.

  • Fig. 1

    Brain Damage Recovery Chances: How To Maximize Recovery Outlook

      Every brain injury is unique, which makes it challenging to predict ones chances of recovery.

      Many factors are involved in determining ones recovery outlook after TBI, including the severity of injury, age, prior functional levels, and the onset of secondary complications. Fortunately, even with the most severe cases of brain damage, there is always a chance to recover.

      To help you better understand recovery outlook after brain damage, this article will share:

      S To Increase Brain Damage Recovery Chances

      Utilizing a combination of various rehabilitation methods can promote better chances of brain damage recovery. Because traumatic brain injuries can affect a wide variety of cognitive and motor functions, a personalized approach to recovery that identifies and targets each individuals weaknesses is ideal.

      Commonly used practices to improve recovery outcomes after brain injury include:

      Rehabilitative therapies will provide you with helpful guidance to promote recovery, but its ultimately up to you to continuously practice those exercises and activities to optimize your outcomes. The more you practice, the more your brain will adapt, and the better youll get.

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      Are There Different Types Of Brain Avms

      • True arteriovenous malformation . This is the most common brain vascular malformation. It consists of a tangle of abnormal vessels connecting arteries and veins with no normal intervening brain tissue.
      • Occult or cryptic AVM or cavernous malformations. This is a vascular malformation in the brain that doesnt actively divert large amounts of blood. It may bleed and often produce seizures.
      • Venous malformation. This is an abnormality only of the veins.
      • Hemangioma. These are abnormal blood vessel structures usually found at the surface of the brain and on the skin or facial structures.
      • Dural fistula. The covering of the brain is called the dura mater. An abnormal connection between blood vessels that involve only this covering is called a dural fistula. Dural fistulas can occur in any part of the brain covering. Three kinds of dural fistulas are:
      • Dural carotid-cavernous sinus fistula. These occur behind the eye. Patients have eye swelling, decreased vision, redness and congestion of the eye. They often can hear a swishing noise.
      • Transverse-Sigmoid sinus dural fistula. These occur behind the ear. Patients usually complain of hearing a continuous noise that occurs with each heartbeat, local pain behind the ear, headaches and neck pain.
      • Sagittal sinus and scalp dural fistula. These occur toward the top of the head. Patients complain of noise , headaches, and pain near the top of the head; they may have prominent blood vessels on the scalp and above the ear.

      Brain Hemorrhage Symptoms & Signs

      Blood

      The Worst Headache of Your Life

      “Doctor, I have the worst headache of my life.” Those words send up a warning when a doctor walks into a room to see the patient. The textbooks say that this symptom is one of the clues that the patient may be suffering from a subarachnoid hemorrhage from a leaking cerebral aneurysm. These words don’t mean that a disaster is waiting to happen, but the red flag is waving. If those words are associated with a patient who is lying very still, complaining of a stiff neck, and has difficulty tolerating the lights in the room, this makes the suspicions rise even higher. Add vomiting and confusion as associated symptoms, and the sirens are going off in the doctor’s head. Something bad is happening and time is critical.

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          Measurement Of Enzyme Activities Associated With Respiratory Chain Complexes And Atp Levels

          Mitochondrial respiration complex activity was measured in ICH hemispheres or in SH-SY5Y cell homogenates as described before,. Briefly, ICH hemispheres or cultured cells were homogenized and sonicated in the isolation buffer containing 250;mM sucrose, 20;mM HEPES, pH 7.2, and 1;mM EDTA. Complex I activity was determined in 25;mM potassium buffer containing KCl, TrisHCl and EDTA . The change in absorbance was monitored at 340;nm wavelength every 20;s for 6;min using an Amersham Biosciences Ultrospect 3100 pro spectrophotometer. For homogenized samples , the oxidation of NADH was recorded for 3;min following the addition of 2;µg/mL antimycin, 5;mM MgCl2, 2;mM KCN, and 65;µM co-enzymes Q1 to the assay mixture, and then 2;µg/mL rotenone was added to the mixture. The absorbance of samples was measured for another 3;min. Enzyme activities in complex II , complex III , complex IV , and citrate synthase were determined as described previously. ATP levels were measured using an ATP Bioluminescence Assay Kit following the manufacturers instructions. ICH hemispheres and SH-SY5Y cells were homogenized in the lysis buffer provided in the kit, incubated on ice for 15;min, and centrifuged at 14,000g for 15minutes. Subsequent supernatants were measured for the ATP levels using Luminescence plate reader with an integration time of 10;s.

          Can You Fully Recover From A Hemorrhagic Stroke

          Surviving a hemorrhagic stroke depends on the severity of the stroke and how fast the person is able to get treatment. Unfortunately, the majority of people who have a stroke die within a couple of days. About a quarter of survivors are able to live longer than five years, but the recovery process is long and slow.

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          Carotid Angioplasty And Stenting

          An alternative, newer form of treatment, carotid angioplasty and stenting , shows some promise in patients who may be at too high risk to undergo surgery. Carotid stenting is a neurointerventional procedure in which a tiny, slender metal-mesh tube is fitted inside the carotid artery to increase the flow of blood blocked by plaques. Access is gained through a small groin incision, but no incision is made in the neck. The stent is inserted following a procedure called angioplasty, in which the doctor guides a balloon-tipped catheter into the blocked artery. The balloon is inflated and pressed against the plaque, flattening it and reopening the artery. The stent acts as scaffolding to prevent the artery from collapsing or from closing up again after the procedure is completed.

          There are several potential complications of endovascular treatment. The most serious risk from carotid stenting is an embolism caused by a disrupted plaque particle breaking free from the site. This can block an artery in the brain, causing a stroke. These risks are minimized using small filters called embolic protection devices in conjunction with angioplasty and stenting. There is also a slight risk of stroke due to a loose piece of plaque or a blood clot blocking an artery during or right after surgery. The risks are balanced against the advantages of a shorter occlusion time , shorter anesthesia and a small leg incision.

          Prediction Of Hematoma Expansion

          Unruptured Brain Aneurysm Clipping Surgery – My Story

          Because hematoma expansion is a major determinant of mortality and functional outcome, it could be potentially beneficial to identify those patients at highest risk of hematoma expansion. Prediction scores have been published to predict hematoma expansion in ICH . Prediction scores share several common factors: shorter time from ICH onset to CT; warfarin use; and evidence of spot sign on CTA . The risk of hematoma expansion varies from 3.47.1;% in patients with no risk factors to 7085.5;% in patients obtaining the maximum score .

        • Time from ICH onset to CT. As discussed previously, hematoma expansion tends to occur early in the course of ICH , with the majority of significant hematoma growth happening between baseline and 1-hour CT scans, compared with only 12;% between 1-hour and 20-hour CT scans. It is not surprising that a shorter time between ICH onset and CT scan would appear to be a predictor of hematoma expansion, because CT scans performed more than 6;hours after ICH onset would probably miss hematoma growth that may have already occurred .

        • Patients on warfarin >1.5) have an adjusted OR of 4.04 for hematoma expansion compared with patients not on warfarin. Warfarin-related ICH is discussed in the anticoagulant-associated ICH section.

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          What Causes A Haemorrhagic Stroke

          High blood pressure

          The main cause of haemorrhagic stroke is damage to the very small arteries inside the brain, which is often related to high blood pressure .;

          This process, called small vessel disease, makes the small arteries in the brain more prone to bleeding.;Cerebral amyloid angiopathy

          This is a common type of small vessel disease where a protein called amyloid builds up inside the small blood vessels near the surface of the brain. The resulting damage can cause a vessel to tear, causing bleeding.

          This condition is more common among older people, and older people with dementia. Although there are no proven treatments for CAA, controlling blood pressure can help reduce the risk of bleeding in the brain.

          Magnetic resonance imaging scans have shown that CAA is present in patients with bleeds in specific areas of the brain near to the surface , known as lobar intracerebral haemorrhage. Smaller bleeds, which can be detected on MRI scans, are called microbleeds. Microbleeds are a common feature of CAA and often appear without symptoms.

          Burst aneurysm

          An aneurysm is a weak spot on an artery that has ballooned out. Artery walls are usually thick and strong, but the walls of an aneurysm are thin and weak because they have been stretched. Aneurysms most commonly occur in the main artery leading away from the heart , and the brain.

          What Different Types Of Treatment Are Available

          • Medical therapy. If there are no symptoms or almost none, or if an AVM is in an area of the brain that cant be easily treated, conservative management may be called for. These patients are advised to avoid excessive exercise and stay away from *blood thinners like warfarin.
          • Surgery. If an AVM has bled and/or is in an area that can be easily accessed, then surgery may be recommended.
          • Stereotactic radiosurgery. An AVM thats not too large but is in an area thats difficult to reach by regular surgery may be treated with stereotactic radiosurgery. In this procedure, a cerebral angiogram is done to localize the AVM. Focused-beam high energy sources are then concentrated on the AVM to cause a scar and allow the AVM to clot off.
          • Interventional neuroradiology/endovascular neurosurgery. It may be possible to treat part or all of the AVM by placing a catheter inside the blood vessels and blocking off the abnormal vessels with various materials, such as glue or coils.

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          What Is A Brain Avm

          Normally, arteries carry blood containing oxygen from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. When an arteriovenous malformation occurs, a tangle of blood vessels in the brain bypasses normal brain tissue and directly diverts blood from the arteries to the veins.

          How A Subarachnoid Haemorrhage Is Treated

          Intracranial Hemorrhage

          A person with a suspected subarachnoid haemorrhage needs;a CT scan in hospital to check for signs of bleeding around the brain.

          If a diagnosis of subarachnoid haemorrhage is confirmed or strongly suspected,;you’re likely to be transferred to a specialist neurosciences unit.

          Medication will usually be given to help prevent short-term complications, and a procedure to repair the source of the bleeding may be carried out.

          Read more about:;

          Read more about the causes of subarachnoid haemorrhages.

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          What Doctors Specialize In Treating Brain Avms

          • Vascular neurosurgeons specialize in surgical removal.
          • Radiation therapists/neurosurgeons specialize in stereotactic radiosurgery treatment.
          • Interventional neuroradiologists/endovascular neurosurgeons specialize in endovascular therapy.
          • Stroke neurologists specialize in the medical management of brain AVMs. Neuroradiologists specialize in the diagnosis and imaging of the head, neck, brain and spinal cord.

          . Each type of medication has a specific function to prevent a blood clot from forming or causing a blocked blood vessel, heart attack, or stroke.)

          Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.

          How Are Brain Hemorrhages Treated

          Any type of bleeding inside the skull or brain is a medical emergency. If you or a loved one have experienced a blow to the head or have symptoms that may indicate a brain bleed, call 911. It is important to get to a hospital emergency room immediately to determine the cause of the bleeding and to begin medical treatment.

          If a stroke has occurred, the cause must be determined so that the appropriate treatment can be started. Prompt medical treatment can help limit damage to the brain, which will improve your chance of recovery.

          Surgery may be needed in the following situations:

          • Bleeding may require immediate decompression of the brain to release pooled blood and relieve pressure. Decompression may be done through a burr hole procedure , a craniectomy incision , or a craniotomy .
          • A cerebral aneurysm that has not ruptured may require clipping or filling of the aneurysm through a craniotomy surgical procedure, or an angiography-type procedure to prevent a future rupture.
          • An arteriovenous malformation that has not ruptured is treated by direct removal of the AVM through surgery, use of computer-guided radiation to close off the abnormal vessels or use of a special glue or other filler to block the blood flow from smaller blood vessels into the AVM or the vessels that supply the AVM.
          • Some brain hemorrhages do not require surgery. The decision depends on the size, cause and location of the bleed and other factors.

          Other treatments may include:

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          Diagnostic Tests For Intracerebral Hemorrhage

          In the appropriate clinical setting, emergency neurodiagnostic imaging of the brain is required to emergently assess the possibility of bleeding into the brain substance. Once the location of the hemorrhage is identified by history, exam and neuroimaging, other direct diagnostic tests may be pursued as appropriate.

          Epidemiology Of Intracerebral Hemorrhage

          Brain Stroke is Preventable and Treatable

          Intracerebral hemorrhage represents approximately 10% to 15% of all strokes. About 2 million of the 15 million strokes worldwide are intracerebral hemorrhages.; Men are more likely to suffer an intracerebral hemorrhage than women.

          Each year, approximately 37,000 to 52,400 people suffer from an intracerebral hemorrhage. The number of intracerebral hemorrhages is expected to increase substantially over the next few decades as the population ages. Major underlying causes for the increase in incidence include more frequent use of anticoagulant medication and age related changes in the brain itself.

          There is racial variation in the incidence of bleeding into the brain substance; Asians, Latin American, Mexican American, Native American and African American patients have a greater risk according to epidemiological data. The variation relates to differences in genetics, rates of elevated blood pressure, diabetes, low cholesterol and disease of the small arteries in the brain.

          In a recent review, 34% of patients died from their intracerebral bleed 3 months after the event. Another study documented death rates after an intercerebral bleed of 31% at 7 days, 59% at one year, 82% at 10 years and more than 90% at 16 years. Clearly this is a serious and frequently fatal condition.

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          The Outlook For Hemorrhagic Stroke Patients

          Your outlook for recovery depends on the severity of the stroke, the amount of tissue damage, and how soon you were able to get treatment. The recovery period is long for many people, lasting for months or even years. However, most people with small strokes and no additional complications during the hospital stay are able to function well enough to live at home within weeks.

          Abbreviations Used In This Paper:

          An SICH is defined in this review as a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. An SICH can be classified as either primary or secondary depending on the underlying cause of the hemorrhage. Primary ICH accounts for approximately 70 to 80% of cases and is due to spontaneous rupture of small vessels damaged by hypertension or amyloid angiopathy. Secondary ICH is associated with a number of congenital and acquired conditions such as vascular anomalies, coagulopathies, tumors, and various drug therapies. Table 1 provides a summary of the important causes of SICH. Its most frequent sites are the basal ganglia, thalamus, subcortical white matter of the cerebral lobes, cerebellum, and brainstem.

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          Who Is At Risk For Hemorrhagic Stroke

          The key risk factors include previous stroke and cerebral bleeding and a history of hypertension. Other noteworthy risks may include age, race, and amyloid angiopathy. Neoplasm, vasculitis, bleeding disorders, vascular malformations and aneurysms, trauma, age, and anticoagulant use also may increase risk.

          Understanding The Chances Of Brain Damage Recovery

          Intracerebral hemorrhage: Symptoms, risk factors, and ...

          A persons chances of recovery after TBI heavily depend on the severity of their injury. Generally, the more severe the brain damage is, the lower an individuals chances of making a functional recovery are. This is not always the case, but its the general outlook.

          One way to measure the severity of brain damage after TBI is through the Glasgow Coma Scale . It assesses how conscious a patient is after brain injury based on their eye-opening, motor, and verbal responses. Patients are assigned a score between 3-15. Higher GCS scores are associated with greater consciousness and less severe head injury, which generally suggests better chances of brain damage recovery. However, even after severe brain injuries, recovery is possible.

          According to one comprehensive study of 189 patients with a GCS score of 3,;13% achieved a good functional outcome;after six months. While this may sound discouraging at first, its actually remarkable news considering that the patients started with no consciousness and were only studied for 6 months.

          In a separate study that followed patients with severe TBI for four years,;28% achieved a full recovery, and 79% were living independently with only minimal assistance.

          Other sources show slightly better odds. According to statistics gathered from the;TBI Model System Program regarding individuals with moderate to severe brain damage, at two years post-injury:

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