Cerebral haemorrhage is bleeding within or around the brain resulting from rupture of a blood vessel. It is a form of stroke (specifically a haemorrhagic stroke) and is a serious medical emergency. There are two main types: intracerebral haemorrhage, in which bleeding occurs directly within the brain tissue, and subarachnoid haemorrhage, in which bleeding occurs in the space between the brain and the surrounding membranes (subarachnoid space), usually from a ruptured aneurysm.
Causes include hypertension (the most common cause of intracerebral haemorrhage, as chronically elevated pressure weakens vessel walls), cerebral aneurysm rupture, arteriovenous malformations, trauma, and blood clotting disorders. Anticoagulant use can increase the risk and severity of cerebral haemorrhage.
In the context of cardiac arrest, cerebral haemorrhage is relevant in several ways. It can itself cause cardiac arrest through sudden raised intracranial pressure triggering arrhythmia (neurogenic cardiac arrest). Conversely, cardiac arrest followed by hypoxic brain injury can be mistaken for or complicated by haemorrhage. In post-arrest care, CT head imaging is performed to exclude haemorrhage before targeted temperature management is initiated, as the two conditions require different management. Anticoagulation therapy used to treat cardiac conditions must be carefully weighed against haemorrhage risk in patients with prior brain bleeding.
Symptoms of cerebral haemorrhage include sudden severe headache (‘thunderclap’), loss of consciousness, focal neurological deficits (weakness on one side, speech disturbance), and seizures. It is diagnosed by CT or MRI brain imaging and requires urgent neurosurgical assessment.
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