Medical brain notes 7

  BRAIN HEMORRHAGE Brain Hemorrhage is a more serious type of brain attack and accounts for 20% of the cases of strokes occurring due to the faults in blood vessels. The remaining occur due to thromboembolism. This is a serious disease of the brain in which there is bleeding in the brain either due to the rupture of a blood vessel or some other reason. Most of the patients become unconscious in minutes and if timely treatment is not given, it proves fatal for many patients. Brain hemorrhage can be classified into two groups:   1. Intracerebral Hemorrhage: Occurs due to either high blood pressure or because of the accumulation of a substance called Amyloid (Amyloid Angiopathy) in the blood vessel.   2. Subarachnoid Hemorrhage: an unnatural swelling on the blood vessel (saccular aneurysm), or formation ofan entangled mass of abnormal blood vessels (AN. Malformation) might rupture and cause hemorrhage. In addition to these, side effects of anticoagulant type of medicines, he...

  Intra Cerebral Hemorrhage : Rupture of blood vessels deep inside the brain due to high blood pressure is called intracerebral hemorrhage. This hemorrhage occurs at some particular locations in the brain (like Putamen, Thalamus, Cerebellum) and usually while examining the patient; the physician can easily identify the location, by its specific signs and symptoms. Amyloid Angiopathy is s a kind of cerebral hemorrhage occurring mostly in elderly people and it can recur frequently. If all these hemorrhages are diagnosed quickly and immediate treatment is initiated to reduce the edema of the brain and control of blood pressure, the death rate in the cases of cerebral hemorrhage can be brought down considerably. At present the death rate is as high as 50% to 60%. In some cases of cerebellarhemorrhage, e.g. temporal lobe hemorrhage or putaminal hemorrhage, lives can be saved by surgery done by a neurosurgeon. The goal of reducing death rate due to cerebral hemorrhage can be achieved by ...

  Subarachnoid Hemorrhage : This type of hemorrhage is completely different from the one discussed before. Most of these patients do not suffer from high blood pressure. Many of them are young and in most of them there is a congenital weakness in the blood vessels causing ballooning of the blood vessel (Saccular aneurysm) or entanglement of the vessels (AN. Malformation). These which rupture at a particular age due to sudden exertion or unknown causes, with oozing of blood into the subarachnoid spaces between the membranes of the brain. This is known as the subarachnoid hemorrhage. It is worth noting that out of every 100 people, at least one may be harboring such a congenital aneurysm in the blood vessels of the brain, but it can never be predicted when it may rupture and in many cases it may not rupture during the entire course of life. Once it ruptures, nearly 45% to 60% patients die within a month. This disease is extremely dangerous and hence it is not only important to unders...

  Investigation of Blood Vessels of the Brain :   The test known as Angiography is the most important test. MR Angiography makes the use of the MRI magnetfor the examination of the blood vessels In this test no catheter is required to be introduced in the blood vessels. Therefore, it is called a Non Invasive test. For coronary angiography, a catheter has to be introduced in a blood vessel and therefore there is a slight risk involved, which is not the case in a MR Angiography. This test can give an accuracy of only 90 to 95% and therefore, can be used only as a screening test. The gold standard tests are the conventional 4 vessel angiography or Digital Substraction Angiography (DSA). An aneurysm is immediately detected on angiography. In 15% cases more than one aneurysm can be present and so it is imperative that the angiography is done on all the four blood vessels of the brain, so that if surgery becomes necessary it can be planned keeping all the aneurysms in mind. The angi...

  Complications : In this disease, there is a definite risk of rebleeding due to rerupture of the aneurysm, any time in the next month. Usually this is fatal or very serious. Similarly, between 4 to 12 days of primary bleeding, there is a spasm in the vessel distal to aneurysm - so called vasospasm. This is the cause of delayed paralysis and morbidity. This can be largely prevented with the help of drugs and hydration. Further, salt depletion and seizures are also nons known complications.                So, once the diagnosis is confirmed, in appropriate cases the aneurysm is clipped by surgery. It is either covered by a tissue or a plastic coating is done. Sometimes the Carotid artery in the neck is tied for the treatment. In the cases of large aneurysms, treatment is also done with the help of balloon.                For treating AV Malformation, Bloc...