Types of brain hemorrhage and clinical manifestations

Clinical manifestations during the recovery period of brain hemorrhage

After active rescue and treatment, patients with controlled brain hemorrhage or those with mild bleeding may gradually improve their consciousness after a period of coma or lethargy, and then enter the recovery period. At this time, necessary treatments such as puncture, medication, and massage are given, and the symptoms of triple deviation will gradually improve. Paralysis first disappears, and hemiplegia generally recovers slowly.

Types of brain hemorrhage and clinical manifestations
Types of brain hemorrhage and clinical manifestations

The activity function of the paralyzed limb, the recovery of the lower limb is faster than that of the upper limb. The proximal joints of the upper and lower limbs, such as the elbow joint and shoulder joint, recover earlier and better than the distal joints of the hands and feet. The fine motor skills of the fingers, such as holding chopsticks, writing, and grasping small objects, recover late and poorly.

The sequelae period of intracerebral brain hemorrhage

After 15 days to 6 months of active treatment, the stroke symptoms of most patients with intracerebral hemorrhage can recover to normal or near normal. If the bleeding volume is large or the patient receives inadequate or incorrect treatment, even after more than 6 months, the patient still has symptoms such as hemiplegia, which is called the sequelae period. At this stage, the recovery of most patients becomes extremely slow, and varying degrees of limb paralysis and speech impairment remain. Patients with left-sided intracerebral hemorrhage often experience aphasia. The paralyzed limb often has nutritional disorders, muscle contractures and pain, and intellectual decline compared to before.

How to judge whether it is hemorrhage in the pons?

The pons is a part of the brainstem, located at the anterior inferior edge of the posterior head and small brain. This area has less chance of bleeding, accounting for only 5% of all cerebral hemorrhages, and the arteries prone to bleeding are the median pontine arteries.

Hemorrhage in the pons is a more dangerous type of stroke, often suddenly onsetting and rapidly leading to deep coma. Facial paralysis and limb hemiparesis are characterized by crossed symptoms, that is, if the left facial paralysis occurs, the mouth and eyes are twisted to the opposite side, and simultaneous right upper and lower limb paralysis occurs. Severe hemorrhage can extend to the opposite side, resulting in spastic quadriplegia. The characteristic symptoms of pontine hemorrhage include extremely narrowed pupils, similar to needle tips.

It can also present with bilateral globe deviation, such as the left eye deviating to the left and the right eye deviating to the right, which is called dissociative strabismus in medicine. In addition, pontine hemorrhage can be complicated by central fever, with a temperature as high as over 40°C. Convulsions, irregular breathing, or rapid breathing followed by brief cessation of breathing and then rapid breathing like waves can occur. This type of breathing is called “agonal breathing.” Pontine hemorrhage can lead to death in a relatively short period, with about 3/4 of the patients dying within 24 hours of onset.

What are the clinical symptoms of cerebellar hemorrhage?

Cerebellar hemorrhage accounts for 2% to 4% of hemorrhagic strokes, with the cerebellar dentate nucleus artery being prone to bleeding, and the left side being more susceptible than the right. Cerebellar hemorrhage often presents with an acute onset, the first symptoms being dizziness and severe headaches, vomiting, accompanied by nystagmus, unclear speech, and weakness of the quadriceps muscles. Due to the sudden onset, patients can quickly fall into a coma, making it difficult to detect signs of compression of the cerebellum.

The absence of hemiplegia is a characteristic of cerebellar hemorrhage. Severe cerebellar hemorrhage can affect the brainstem, causing obvious brain edema and brainstem compression symptoms, such as episodic rapid breathing. If rescue is not timely, patients often die within a few hours.

What are the clinical symptoms of intracerebral hemorrhage?

The incidence of stroke caused by intracerebral hemorrhage is relatively low, accounting for about 2%. Primary intracerebral hemorrhage is rare, and most are secondary to intracerebral hemorrhage, further developing from general cerebral hemorrhage. The condition progresses rapidly, with deep coma, generalized muscle rigidity, early onset of episodic tetanic spasms, high fever, with a temperature above 40°C. It is often accompanied by tachycardia, facial congestion, flushing, profuse sweating, and cyanotic lips and nails. It is particularly prone to causing pneumonia and respiratory distress. Gastrointestinal manifestations include large gastric ulcers, coffee-colored vomiting, or black tar-like stools, and incontinence of bowel and bladder. The prognosis is usually poor, and death often occurs within 24 hours.

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