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.
CausesAn 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
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).
You will be admitted to the Intensive Care, Medium Care, or Stroke Unit if accurate monitoring and support of important bodily functions is necessary. Examples are respiration, blood pressure support, observation of the pressure in your head, or the heart rhythm. If your situation allows for it and you do not need continuous monitoring or support for bodily functions, you will be transferred to the nursing ward.
If the situation permits, you will be admitted to the nursing ward. You will typically stay in a single room. You will be checked regularly and your bodily functions will be monitored. We offer as much peace and safety as possible. As your situation becomes less pressing, the medical team at the nursing ward will map out the problems that remain after the hemorrhage, and speak with you and your loved ones about how and where you can best recover from the bleeding.
You will be cared for and observed by a specially trained nurse. This nurse is responsible for observation and care, and for the coordination of care.
A doctor is available 24 hours a day for the medical treatment, under the supervision of a medical specialist from the department. The medical specialist and the doctor in the department are in contact on a daily basis to discuss your treatment and policy. Every morning the doctor will visit you during visitation rounds in the ward and they will check with you and the nurse regarding your treatment progress. You will hear the results of the tests during the visit. If new tests are planned, the nurse will give you verbal and written information. If needed, an additional meeting with the doctor can be planned.
The effects of the ICH may be different. There may be hemiplegia (paralysis on one side), difficulties with swallowing and speech, and cognitive issues (difficulty thinking). That is why you will meet therapists in the various departments who will map out and treat the consequences of the ICH for your general function.
The treatment team consists of several professionals. They consult with each other. The goal is for you to receive guidance and information from the same people as much as possible during the admission.
The treatment team consists of:
- Treating neurosurgeon/neuro-intervention specialist: the doctor performing the treatment.
- Departmental physician: present at the IC, MC, or nursing ward from Monday to Friday from 9:00 am to 5:00 pm. They responsible for the implementation and continuity of daily medical care. A doctor is available 24 hours a day in the nursing ward.
- Intensivist: the doctor who treats you in Intensive Care. This doctor is available 24 hours a day.
- Nurse: responsible for the coordination of care, monitors you, assists you in your daily care, administers medication, and carries out actions on behalf of the doctor.
- Nursing specialists: monitors continuity, helps you think about your recovery process, is your contact person, and performs outpatient check-ups. During these check-ups, they will map out your complaints, discuss the influence of the complaints on your daily activities and, if necessary, refer you to the correct professional.
- Rehabilitation doctor: coordinates the care of co-treating therapists such as those who assist with speech therapy, physiotherapy, and occupational therapy, and advises you on your recovery process.
- Physiotherapist: treats problems regarding movement, breathing, coughing, or recovery.
- Speech therapist: treats problems with swallowing or speaking. You will also be treated by the speech therapist if you have a breathing tube (trachea cannula).
- Occupational therapist: identifies problems in daily function and can, if necessary, provide adaptive aids (e.g. wheelchair).
- Dietician: gives advice in the event of problems with nutrition or the nutritional situation.
- Social worker: provides support when there are social or societal problems, such as problems caused by legal incapacity or possible financial consequences of the disorder.
- Pastoral care staff: can support you and your loved ones in matters regarding spiritual and philosophical meaning.
- Transferpunt Zorg: the healthcare referral center, which arranges home care, care aids, or accommodation in a nursing home after hospitalization.
You may be confused and restless because of an ICH and this can lead to unsafe situations. To ensure your safety, it is sometimes necessary to use wrist, ankle, and abdominal straps made of fabric. These measures are generally not considered to be pleasant. If these measures are necessary, we will discuss them with you and your contact person.
After an ICH, all patients receive a number of medications such as painkillers, medication that improves the blood circulation in the brain, and medication to promote bowel movement.
Home medication such as blood thinners and antihypertensives (blood pressure medications) are usually stopped. You can continue to use other medication.
TreatmentIf 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.
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 homeIf 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 centerFor 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 homeIf 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 homeIf 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 homeIf 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.
If you are discharged and you do not need nursing care during the transport, your loved ones may pick you up from the nursing ward.
If you are transferred to another institution and need nursing care during your trip, the nurse in the department will arrange for you to be transported by ambulance.
The nurse gives the medical and nurse transfer to the ambulance attendant. Your general practitioner will receive a letter stating what treatment you have had.
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.
Intracerebral hemorrhage has a major impact on your daily life, not only for you, but also for your partner and family members. You may not be able to remember a period of time during your admission once you have been discharged. The majority of people continue to suffer from issues after the hemorrhage. The most common symptoms after six months are:
- headache or pressure on the head
- changes in mood (anxiety, rapid anger, depression, stress)
- memory problems
- problems with concentration
- acting and thinking more slowly
- reduced or absent sense of taste and smell
- poorer hearing
- poorer vision
Aftercare is organized differently for each treatment center in the Netherlands.
SmokingSmoking is a significant risk factor for the development of intracerebral hemorrhage. In the presence of psychological issues, such as depression, stress, or anxiety, it may even be more difficult to stop smoking or to continue not smoking. It is important that you seek professional guidance from your general practitioner or nurse practitioner if you find it difficult to stop smoking. It is also known that the chance of success in quitting smoking is many times greater if family members stop smoking out of solidarity and for their own health as well.
Blood pressureAnother significant risk factor for developing an intracerebral hemorrhage is high blood pressure. Have your blood pressure checked regularly by your general practitioner and treated with medication if it is too high. Symptoms of high blood pressure may include headaches, palpitations, or tinnitus. It may also be discovered by chance. High blood pressure is more common in people who are stressed, overweight, who smoke, eat a lot of salty food, or are experiencing a stressful situation in the family. It also occurs with kidney problems.
In addition to medication, it is important to change your lifestyle. Consult your general practitioner or nurse practitioner for advice and guidance on these lifestyle changes.
There are no recommendations restricting pregnancy after intracerebral hemorrhage.
After an intracerebral hemorrhage, a 6-month driving suspension is required. If, after this period, there are any residual symptoms that affect driving ability, a specialized report from your specialist is required. On the basis of this report, the Dutch central driver licensing office (CBR) can decide whether an additional independent medical examination or a driving test is required. Your medical specialist will write the specialized report in addition to the health certificate issued by the CBR.
In the case of epilepsy as a result of intracerebral hemorrhage, you can be declared fit to drive for a certain period of time after the end of an attack-free period. The duration of the seizure-free period depends on several factors. Discuss with your specialist what applies to you.
Rehabilitation aimed at improving complaints and limitationsBrain 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. read more
Rehabilitation aimed at improving complaints and limitations
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 stageSometimes 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.
AftercareIn 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.