How is a brain hemorrhage treated?

  1. How should cerebral hemorrhage be treated?  For patients with a small amount of cerebral hemorrhage, conservative medical treatment such as dehydration, hemostasis and neurotropism can be performed, while actively preventing and treating complications.  For patients with larger bleeding volume (e.g. >30ml) or with impaired consciousness, as well as patients with cerebellar hemorrhage with deterioration of neurological function or hydrocephalus caused by brainstem compression and/or ventricular obstruction, surgical removal of hematoma should be performed as soon as possible.  In patients with high cranial pressure who have developed coma, or large hematoma with significant midline shift, or in whom pharmacological treatment is ineffective, decompression with debridement can be considered along with hematoma removal.  For patients with moderate hematoma volume, minimally invasive hematoma removal (e.g., stereotactic or endoscopic puncture aspiration, postoperative thrombolytic drug injection) can be considered.  2. What should I do if my blood pressure is very high after cerebral hemorrhage? What is the best condition to control?  Elevated systolic blood pressure after cerebral hemorrhage is correlated with hematoma expansion, neurological deterioration, disability and mortality. Therefore, for small to moderate hemorrhage with systolic blood pressure between 150 and 220 mmHg after hemorrhage, urgent reduction of systolic blood pressure to 140 mmHg is safe if there is no contraindication to acute hypotension and may help improve the functional prognosis of the patient. Patients with systolic blood pressure >220 mmHg should also be aggressively lowered intravenously with continuous blood pressure monitoring.  In massive hemorrhage, because of the high intracranial pressure, it is not advisable to lower the blood pressure too low until it is necessary for proper management of the hematoma and effective control of intracranial pressure.  3. Is the prognosis of cerebral hemorrhage good?  In addition to small cerebral hemorrhage, the prognosis for patients with moderate to large cerebral hemorrhage is still unsatisfactory. Some patients die in the acute stage due to excessive illness or complications, and about half of the survivors need assistance in daily life, so special emphasis is placed on rehabilitation treatment for such patients, especially within 3 months of cerebral hemorrhage.  4. What are the common complications in patients with cerebral hemorrhage?  Cerebral hemorrhage, especially in patients with heavy bleeding, can lead to a variety of complications, such as hemiplegia, aphasia, coma, epilepsy, pneumonia, dysphagia and aspiration, respiratory failure, sepsis, myocardial infarction, stress ulcers, venous thrombosis and pulmonary embolism of the lower extremities, decubitus ulcers, depression and anxiety.