patients Cerebral hemorrhage Intracerebral hemorrhage

About an intracerebral hemorrhage

In the event of an intracerebral hemorrhage, blood is present in the brain tissue. You will be admitted to the ER to treat the effects of the hemorrhage.

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About an intracerebral hemorrhage

In the event of an intracerebral hemorrhage, blood is present in the brain tissue. You will be admitted to the ER to treat the effects of the hemorrhage.
Symptoms of intracerebral hemorrhage include: acute and severe headache, nausea, neurological deficits, and reduced consciousness or loss of consciousness.
The course and prognosis of the hemorrhage depends very much on the cause and severity. 

Causes

An intracerebral hemorrhage at a young age can have various causes, such as high blood pressure (hypertension), vascular abnormalities, or a brain tumor.

Disorders of the brain vessels that cause intracerebral hemorrhages most often at a young age are:

Admission to hospital

It is essential that you seek out emergency care after an intracerebral hemorrhage and visit a hospital where the effects of the aneurysm can be treated.

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Admission to hospital


  • If you are admitted to hospital because the doctors think you have a cerebral hemorrhage, a CT (Computer Tomography) scan of the brain will be taken. This allows the doctor to see what kind of cerebral hemorrhage you have had. The blood vessels can be seen in the CT scan by injecting contrast medium into your arm via an IV, so that the doctor can detect any vascular abnormalities. A cause is often not found on a CT scan of the cerebral blood vessels.
     
    If there is any doubt about the cause of the hemorrhage, the team of vascular specialists may decide to conduct further tests. This is done by means of a vascular examination (angiography).


Treatment

If you have increased intracranial pressure as a result of the cerebral hemorrhage, the doctor will consider placing a shunt and a pressure gauge through the skull into a ventricle of the brain.

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Treatment

If you have increased intracranial pressure as a result of the cerebral hemorrhage, the doctor will consider placing a shunt and a pressure gauge through the skull into a ventricle of the brain. This enables cerebrospinal fluid to run out and reduce the pressure in the brain. Intracranial pressure may also be measured. You will be admitted to the Intensive Care Unit, the Medium Care Unit, or Stroke Unit.
 
If the hemorrhage occupies a large area and the brain is pushing itself against the skull, the doctor may consider removing the hemorrhage surgically. If extreme swelling of the brain occurs, part of the skull may temporarily be removed during the swelling period. The missing part of the skull can be replaced after 3 months if you have recovered sufficiently. During the recovery period, you will be fitted with a helmet to protect the brain.
The intensivist and the neurosurgeon discuss the treatment plan with your contact person.

Complications

Complications following an intracerebral hemorrhage can be very different and depend on the size and location of the bleeding. Here we explain the most common complications.

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Complications


  • Hydrocephalus is the accumulation of cerebrospinal fluid in the ventricles of the brain. Hydrocephalus can develop acutely if the bleeding causes the passage between the ventricles of the brain close and the cerebrospinal fluid cannot drain out. It can also develop gradually when the relatively large blood cells stop the drainage of the water-thin cerebrospinal fluid. The "drain" then becomes clogged, which causes the pressure in the brain to increase. Due to the high pressure in the brain, the patient is always suffering from drowsiness, and there may be a downward pressure on the eyes or narrow and non-responsive pupils. Usually there is an increase in headache, nausea, and vomiting.
     
    In that case, cerebrospinal fluid drainage is required. You can read more about this under the heading Cerebrospinal Fluid Drainage.


Discharge from hospital

In the course of admission to the nursing ward, the neurosurgeon's medical treatment gradually tapers off. Your stay will be more about rehabilitation.

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Discharge from hospital

In the course of admission to the nursing ward, the neurosurgeon's medical treatment gradually tapers off. Your stay will be more about rehabilitation.
During recovery, your medical team will advise you on the best place to recover after hospitalization.

Discharge to home

If daily function can be resumed independently and safely, you can go home after your discharge. Your family or friends can pick you up at the agreed upon time. For example, if you still require therapy at home, you will be referred to a practice for physiotherapy or occupational therapy. If you need care, the nurse will fill out a request for home care. An expert from the Centrum Indicatiestelling Zorg (Care Assessment Centre - CIZ) will give you advice about the care you need at home.
After some time you may notice at home that you have problems with fatigue, irritation processing, concentration, or memory. This will be discussed during the aftercare consultations and you may still be referred for daytime treatment in a rehabilitation center.


  • Rehabilitation at a rehabilitation center

    For rehabilitation at a rehabilitation center (Medical Specialist Rehabilitation) there must be sufficient capacity and the prospect of a future discharge to the home. If this is chosen, the rehabilitation doctor will register you for this type of rehabilitation. After completion of the neurosurgical treatment, you may be transferred to the regional hospital where you were initially cared for during the waiting period for the time being.

    Rehabilitation in a nursing home

    If your strength is so limited that you still need a lot of rest between therapy sessions and there is a prospect of a future discharge to the home, you can opt for the Geriatrische Revalidatie Zorg (Geriatric Rehabilitation Care, GRZ) at a nursing home. After completion of the neurosurgical treatment, you may be transferred to the regional hospital where you were initially cared for during the waiting period for the time being. The Transferpunt Zorg (healthcare referral center) assists in choosing from the nursing homes where GRZ is possible, and takes care of the registration.

    Long-term rehabilitation in a nursing home

    If there is still a lot of support needed for daily activities and it is uncertain whether discharge to the home is still possible, a long-term stay with rehabilitation at a nursing home is an option (care indication 9b). The patient will have a longer period of time to recover and, if possible, discharge to the home is an option. After completion of the neurosurgical treatment, you may be transferred to the regional hospital where you were initially cared for during the waiting period for the time being. The Transferpunt Zorg (healthcare referral center) assists in choosing from the nursing homes where it is possible to stay for care indication 9b.

    Vroege Intensieve Neurorevalidatie (Early Intensive Neurorehabilitation - VIN)

    VIN is an intensive rehabilitation program for patients who have suffered serious brain damage and are therefore in a state of impaired consciousness. The VIN program can make a significant contribution to the restoration of consciousness. There are only a few centers in the Netherlands where this program is employed. In the south of the Netherlands this is Libranet, the Leijpark location in Tilburg. The care indication is determined by the rehabilitation physicians of the institution.

    Long-term stay in a nursing home

    If self-care is largely taken over and your doctors expect that you will not recover sufficiently to return home, you may be admitted to a nursing home for a long period of time. This is rare in younger patients with a brain hemorrhage. After completion of the neurosurgical treatment, it is possible that you will be transferred during the waiting period, for the time being, to the regional hospital where you were initially taken care of. The Transferpunt Zorg (healthcare referral center) assists in choosing from the nursing homes where a long-term stay is possible.

     


Life after intracerebral hemorrhage

After a intracerebral hemorrhage, there are a number of things to consider.

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Life after intracerebral hemorrhage

Mogelijk blijft je voor anderen onzichtbare klachten houden. Veelvoorkomende voorbeelden hiervan zijn: (mentale) vermoeid, problemen met het verwerken van prikkels, concentratieproblemen, vergeetachtigheid en hoofdpijn. Dit kan een behoorlijke beperking zijn voor het oppakken van je dagelijks leven.


  • After recovery from intracerebral hemorrhage, there are no special restrictions or rules to follow. Questions often arise about heavy physical labor, pushing, flying, visiting a sauna, roller coaster, or sexual activity. There is no scientific evidence that these activities increase the risk of a new hemorrhage. However, existing complaints may very well increase as a result of these activities. The advice is that all activities can be resumed as long as this is possible without issue.


Rehabilitation aimed at improving complaints and limitations

Brain damage can cause many different complaints, such as loss of strength, memory problems, difficulty speaking, or spasticity. Rehabilitation is aimed at reducing the symptoms and problems in order to be able to function as well as possible again.

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Rehabilitation aimed at improving complaints and limitations

Brain damage can cause many different complaints, such as loss of strength, memory problems, difficulty speaking, or spasticity. Rehabilitation is aimed at reducing the symptoms and problems in order to be able to function as well as possible again. Depending on the complaints and how they limit a person's daily activities, different therapies are used. For example, physiotherapy for problems with walking and occupational therapy when self-care is difficult.

This can sometimes be with a primary care practitioner, i.e. a therapist in the neighborhood. If there are problems in more areas, treatment by a rehabilitation team led by a rehabilitation doctor is usually necessary. You can then be admitted to a rehabilitation center or follow a day treatment program from home in a rehabilitation center.

The rehabilitation doctor may treat spasticity with medication or injections. Speech and language problems are treated by a speech therapist. Cognitive and mood problems are examined and treated by a neuropsychologist. The rehabilitation team often pays attention to resuming work after a stroke at a young age.

Rehabilitation at a later stage

Sometimes problems caused by the brain injury only become apparent after a long period of time. In this case as well, the general practitioner, neurologist, neurosurgeon, or nurse specialist can refer you for treatment by a therapist in the neighborhood, the treatment program Hersenz, or a rehabilitation doctor. Problems that only become apparent after a longer period of time often consist of behavioral changes and cognitive issues, such as difficulty with memory, planning, or dual-tasking and slow thought. This often requires specialized rehabilitation.

Aftercare

In the Netherlands, aftercare is arranged differently for each hospital. In many hospitals this is done at the aftercare outpatient clinic, but it can also be arranged through a home care organization or through rehabilitation.

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Aftercare

In the Netherlands, aftercare is arranged differently for each hospital. In many hospitals this is done at the aftercare outpatient clinic, but it can also be arranged through a home care organization or through rehabilitation. Often, there are regional agreements on this matter. You can contact your therapist for this.
 
In most treatment centers you will be scheduled for an appointment with a nurse specialist or specialized care provider from the aftercare outpatient clinic after the admission. They discuss the questions and problems that have arisen after the hemorrhage. For example, problems with memory, attention, concentration and fatigue, side effects of medication, or new complaints. As a rule, this person is also available for questions. They can give advice or refer you to an organization that can support you in this. Attention is also paid to the presence of risk factors for cerebral hemorrhage such as high blood pressure, smoking, and obesity.