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Importance of an integrated approach after brain hemorrhage (Keyword: Brain Hemorrhage)

What is brain hemorrhage?

 Brain hemorrhage occurs as a result of the rupture or explosion of the veins in brain, causing bleeding in nearby tissues. The brain cells which are not blooded during the brain hemorrhage die. Brain hemorrhage is also named as intra-head or intra-brain bleeding. Approximately 15% of the stroke cases are consisted of brain hemorrhage. Brain hemorrhage can have crippling and life-threatening effects. Brain hemorrhage is a medical urgent situation which necessitates rapid treatment. Memorial Şişli Hospital Physical Therapy and Rehabilitation Department Chair Prof. Dr. Engin Çakar has made significant suggestions regarding brain hemorrhage.

What happens during brain hemorrhage?

The bleeding which happens after trauma causes swelling by degenerating brain tissues. This situation is known as brain edema. The blood is gathered as a mass named as hematoma (the exit of blood outside of the vein as a result of vein rupture and gathering of bleeding in the tissue). This situation increases the pressure on the brain tissue, decreases the vital blood flow, and causes death of brain cells.

Why does brain hemorrhage happen?

There are many causes of brain hemorrhage. The most common ones are:

Head trauma: The head traumas especially happened in the persons above the age 50 as a result of injuries can cause brain hemorrhage.

High blood pressure: The blood vessel walls can be weakened because of chronic high blood pressure. In this situation the untreated high blood pressure can cause brain hemorrhage.

Aneurism: Aneurism is defined as an eminentia or ballooning caused by the weakness of an artery wall in brain. It can cause paralysis by exploding or bleeding into brain.

Blood or bleeding disorders: Blood thinners are seen as a risk factor for brain hemorrhage. Hemophilia and sickle cell anemia may contribute the decrease of thrombocytes and clotting.

Brain tumors: These are also counted among the factors which cause brain hemorrhage.

Types of brain hemorrhage

There are a couple of brain hemorrhage types. The type of brain hemorrhage can vary according to the location of bleeding.

Intracerebral bleeding: It occurs in the brain. It is defined as the bleedings occur within brain tissue (including brain stem).

Subarachnoid bleeding: This type of bleeding happens between the brain and the membrane which cover it. 

Subdural bleeding: This type of bleeding may occur after an injury and develop chronically. This may occur under the inner layer of brain cortex or on the brain.

Epidural bleeding: This type of bleeding occurs when a bleeding between the skull and brain happens.

Every type of brain hemorrhage can form a serious risk against health.

Symptoms of brain hemorrhage

Brain hemorrhage may reveal itself with different symptoms. These symptoms may reveal themselves in shape of a sudden tingling, numbness, weakness, and paralysis in face, arm and leg. It can also happen only in one side of the body. The symptoms of brain hemorrhage vary according to the area of brain. These symptoms can be classified as:

  • Sudden tingling in face, arm or leg, and especially in one side of the body,
  • Weakness, numbness or paralysis,
  • Headache,
  • Nausea and vomiting,
  • Clouding of consciousness,
  • Dizziness,
  • Seizures,
  • Difficulty in swallowing
  • Visual loss or impairment
  • Loss of balance or coordination,
  • Neck stiffness and sensitivity to light,
  • Abnormal or slurred speech,
  • Difficulty in reading, writing or understanding of speech,
  • Changes in the level of consciousness or wakefulness, loss of energy, sleepiness or coma,
  • Problematic breathing and abnormal heartbeat speed

How is the treatment of brain hemorrhage?

If paralysis has occurred as a result of brain hemorrhage, the reason of bleeding should be detected to initiate the suitable treatment. Urgent medical treatment can increase the chance of recovery by helping to decrease the harm given to brain as minimum as possible.

Surgical treatment may be needed after a severe brain hemorrhage. Surgeons may recommend surgical operation to alleviate the pressure on the brain.

When an explosion in arterial blood vessel causes bleeding, surgeon reaches the bleeding brain tissue by takin part of the skull. This process is named as craniotomy (a brain operation in which a piece of skull is removed).

Among the other treatment options, there are the anxiety, anti-epileptic drugs and medications to take the symptoms like seizures and severe headache under control if needed.

It is possible to overcome brain hemorrhage, and it is necessary to apply the correct treatment as soon as possible to do it.

Rehabilitation can help the patients to keep up with normal life after brain hemorrhage. The method of physical therapy and rehabilitation which is applied to treat the situations occurred after brain hemorrhages are named as neurorehabilitation. The comprehensive neurorehabilitation includes:

  • Physical therapy- physiotherapy
  • Ergotherapy- occupational therapy
  • Robotic rehabilitation- robotic physical therapy
  • Speech therapy
  • Swallowing therapy
  • Respiratory therapy
  • Electrotherapy
  • Psychotherapy

Healing period after brain hemorrhage

The physical therapy and rehabilitation support after brain hemorrhage should be started while the patient is in intensive care unit. The aim is to prevent the situations like pressure wounds and joint stiffness while applying passive joint exercises to the unconscious patients. If the consciousness of the patient is open, active exercises are applied on the patient.

Robotic Rehabilitation and Robotic Physical Therapy in Brain Hemorrhage

Robotic physical therapy is used in the treatment of patients with paralysis. Robotic bed Erigo, Walking Robot Lokomat, Hand and Arm Robot Armeo Power, Anti-Gravity Treadmill Alter G are among the robotic physical therapy devices used in the treatment of brain hemorrhage. Besides, respiratory physiotherapy is benefited to strengthen the respiratory muscles.

Speech Disorder Treatment after Brain Hemorrhage

If the speech center is affected after the brain hemorrhage, speech difficulties may be experienced. In this case, an intense speech therapy is applied on the patient.

Brain injury may develop pacify the nerves which enable the automatic movements as a result of brain hemorrhage. When this ability is lost, the nerves should be replaced with the new ones. The lost abilities may be needed to be re-learned like a child.

For the patients with speech difficulties, practices are made regarding the processing of sounds by teaching them the sounds, syllables and words one by one. The duration of this process may vary from person to person.


Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.


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