Can brain hemorrhage recur?

  1. Which patients with cerebral hemorrhage are prone to recurrence?  First-time lobar hemorrhage, elderly patients, gradient-echo magnetic resonance imaging showing microhemorrhagic foci, those on anticoagulation therapy and those carrying the apolipoprotein Eε2 or ε4 allele are prone to recurrence.  2. What can be done to prevent recurrence of cerebral hemorrhage?  There are many risk factors for recurrence of cerebral hemorrhage, but only blood pressure and the use of anticoagulant drugs can be controlled, so recurrence of cerebral hemorrhage should be prevented by the following methods: ① Strict control of blood pressure Make a long-term goal of a systolic blood pressure <130 mmHg and a diastolic blood pressure <80 mmHg.  ②Lifestyle changes: Do not drink alcohol more than twice a day and strictly control the amount of alcohol consumption and quit smoking.  ③Avoid the use of prohibited drugs (such as cocaine, etc.).  ④Treat obstructive sleep apnea to prevent cerebral hemorrhage caused by sudden increase in blood pressure during sleep apnea.  ⑤ Patients with non-valvular atrial fibrillation may need to avoid long-term anticoagulation with warfarin after a warfarin-related spontaneous lobar cerebral hemorrhage.  (⑥Anticoagulation therapy after non-lobar cerebral hemorrhage and antiplatelet therapy after any type of cerebral hemorrhage may be considered as appropriate, especially if there is a clear indication for the use of these agents.  (7) The optimal time for patients to resume oral anticoagulation after the onset of anticoagulant-associated cerebral hemorrhage is unclear. In patients with nonmechanical valve disease, avoiding oral anticoagulants for at least 4 weeks may reduce the risk of cerebral hemorrhage recurrence. If indicated, aspirin monotherapy may be initiated several days after the onset of cerebral hemorrhage.