What are the signs of a cerebral hemorrhage?

introduction

With a cerebral hemorrhage (intracranial hemorrhage) there is bleeding inside the skull. One differentiates one intracerebral haemorrhage (Bleeding into the brain tissue) from one Subarachnoid hemorrhage (Bleeding between the middle and inner layer of the meninges). In both cases, the hemorrhage leads to compression of the surrounding brain areas, an insufficient supply of blood to the brain tissue supplied by the affected vessel and an increase in pressure within the skull. As a result, characteristic symptoms appear depending on the location of the bleeding. However, these are usually not specific to a cerebral haemorrhage and cannot be distinguished from the symptoms of a cerebral infarction. Imaging is therefore necessary for further differentiation.

What are the typical signs of a cerebral hemorrhage - bullet points?

Symptoms of a cerebral hemorrhage are numerous. However, it must be taken into account that not all symptoms have to appear in a patient for a cerebral hemorrhage to be diagnosed. Typically, the symptoms listed below come on suddenly and increase as the disease progresses. Common symptoms of a cerebral hemorrhage are:

• sudden, very severe headache (Annihilation headache)

• Nausea and vomiting, dizziness (unsteady gait, balance problems)

• sudden weakness (Paresis) or paralysis (Plegia) of the muscles, usually limited to one side of the body (Hemiparesis or hemiplegia), especially in the face, arms and legs

• Numbness (also often affecting the arms, legs, or face)

• Speech disorders (aphasia) and speech disorders (Dysarthria)

• Visual disturbances (double vision, blurred vision, unilateral visual field loss, deviating line of sight)

• Other possible symptoms: swallowing disorders, clouding of consciousness (up to unconsciousness or coma), seizure (epileptic fit)

Read about this too Symptoms of a cerebral haemorrhage

a headache

The most common symptom of a cerebral hemorrhage is a headache. Typically, the headache starts suddenly when there is bleeding in the brain. The pain is often preceded by physical strain or exertion. Compared to classic headaches, the pain is significantly stronger and distributed over the entire head, which is why it is also called 'Annihilation headache’Are designated.

The bleeding into the brain tissue leads to an increase in pressure within the skull. This irritates the meninges surrounding the brain, which contain numerous sensitive nerves. As a result, a further increase in pressure (e.g. due to further bleeding or bleeding) within the skull leads to an increase in the patient's headache.

dizziness

In addition to the headache, patients often report dizziness. Because of the bleeding into the brain tissue and the resulting increased intracranial pressure, nerve nuclei in the brain stem and cerebellum are compressed or disturbed. This is where the central regulation of the sense of balance takes place. As a result, the patient may experience a partially diffuse dizziness. Clinically, there is an unsteady gait as well as numerous balance and coordination problems, which can be checked with the help of numerous tests.

Read about this too Dizziness in the head

Pupils

Another sign of a cerebral hemorrhage can be pupils of different sizes and a lack of pupillary reaction when exposed to light. The cranial nerves running inside the skull can be compressed or damaged by the increased pressure resulting from cerebral hemorrhage. The optic nerve (Optic nerve, cranial nerve II) as well as the nerves innervating the muscles of the eyes (Oculomotor nerve, cranial nerve III; Trochlear nerve, IV cranial nerve; Abducens nerve, cranial nerve VI) to be affected. As a result, there may be a lack of pupil reaction when exposed to light or pupils of unequal size at rest can result.

Epistaxis

In isolation, nosebleeds are usually not a sign of cerebral hemorrhage. Nevertheless, frequent and unstoppable nosebleeds can be a sign of a bleeding disorder with an increased tendency to bleed. This increased bleeding tendency, in turn, can be a cause of cerebral haemorrhage. For this reason, a further specialist examination is recommended in the event of severe and frequent nosebleeds.

In addition, severe nosebleeds can also occur in the event of severe falls and injuries to the skull. Together with the other symptoms mentioned, it can be a sign of a traumatic brain injury with bleeding into the brain tissue.

Read more about this under

• Bleeding disorder
• Traumatic brain injury

Slurred speech

Another common symptom of cerebral hemorrhage is slurred speech on the part of the patient (aphasia). Depending on the affected brain area, both speech understanding (Wernicke aphasia) as well as speech production (Broca's aphasia) to be affected. In rare cases, speech understanding and production are impaired (global aphasia).

If there is a disturbance of speech understanding, the spontaneous speech is usually fluent but without any connection. Sentences that have been started are often canceled or repeated.
If there is a disturbance in language formation, spontaneous speech is slowed down and halting. As a result, only short sentences are formed with great effort.

In addition, the patient's speech can also be disturbed by irritation of the cranial nerves supplying the mouth and jaw muscles. Increased intracranial pressure can compress these nerves within the skull, which means that the muscles required for speech formation cannot or only partially contract.

Read more about this under Increased intracranial pressure

fatigue

A cerebral haemorrhage often leads to sudden onset of fatigue and even clouding of consciousness. However, this should not be confused with pre-existing chronic tiredness or exhaustion. Typically, the patient appears altered and defeated within a few seconds. Depending on the size and extent of the bleeding in the brain, consciousness may be clouded to such an extent that the patient is in a coma.

How does a cerebral haemorrhage show in the early phase?

The sudden appearance of the symptoms is characteristic of a cerebral hemorrhage. Typically, the symptoms mentioned above do not all occur at the same time, but increasingly one after the other. The symptoms depend on the location of the bleeding (cerebrum, cerebellum, brain stem). Usually the patient notices the sudden onset of headache and nausea. A spontaneous visual disturbance can also be an early sign of cerebral haemorrhage.On the other hand, paralysis on one side, language or speech disorders as well as clouding of consciousness and changes in personality are often observed by relatives or friends in the further course.

In the further course there is usually an intensification of the respective symptoms. This is due to the fact that the cerebral haemorrhage has an even more displacing effect on the surrounding tissue or that secondary bleeding occurs within the first 24 hours.

What are the typical signs in children?

The suspected diagnosis of a cerebral hemorrhage is much more difficult in (small) children. Even if the symptoms are largely similar to those in adults, children are often unable to describe their pain, nausea or visual disturbances. In addition, recognizing a change in behavior or personality is more difficult, especially in small children.

In order to make the suspected diagnosis of cerebral hemorrhage in (small) children, it is necessary to observe the child closely. Slow and inadequate reactions, blurred speech, persistent tiredness (possibly with impaired consciousness) and loss of appetite (due to nausea) can be the first signs of cerebral hemorrhage in children. Furthermore, pupils of unequal size and a lack of constriction of the pupils when exposed to light can also indicate damage to the brain.

In small children, cerebral haemorrhage and the resulting increased intracranial pressure can also lead to bulging of the skull (Fontanelles) come, as these only ossify within the first years of life.