Detailed Explanation of Hemorrhagic Stroke: Cerebral Hemorrhage and Subarachnoid Hemorrhage

Hemorrhagic stroke is the most serious complication of late-stage hypertension, commonly including cerebral hemorrhage and subarachnoid hemorrhage. (1) Cerebral hemorrhage: commonly known as "brain hemorrhage", it refers to the sudden rupture of blood vessels in the brain parenchyma. The bleeding site is mostly near the internal capsule and basal ganglia, manifested as hemiplegia and aphasia. Brain CT scan is the preferred examination. The treatment principle is quiet bed rest, dehydration to reduce intracranial pressure, blood pressure adjustment, and prevention of further bleeding. Medical treatment requires bed rest for 2 to 4 weeks. Mannitol and diuretics are used to reduce intracranial pressure. Blood pressure adjustment: In the acute phase, when blood pressure is ≥200/110 mmHg, antihypertensive treatment should be adopted to maintain blood pressure at a level slightly higher than the pre-onset level; when blood pressure is <180/105 mmHg, antihypertensive drugs can be temporarily not used. When systolic blood pressure is 180-200 mmHg or diastolic blood pressure is 100-110 mmHg, close monitoring is required. Prevention and treatment of complications include anti-infection, turning over to prevent pressure sores, and prevention of stress ulcers. (2) Subarachnoid hemorrhage: Blood vessels on the surface and base of the brain rupture, causing blood to flow into the subarachnoid space. The onset is sudden, characterized by severe headache, nausea, and projectile vomiting. CT scan is the first-line treatment. The goal of acute treatment is to prevent rebleeding; absolute bed rest for 4–6 weeks is required, avoiding straining during bowel movements and violent coughing. Mannitol is used to reduce cerebral edema. Calcium channel antagonists are used to prevent vasospasm.

Table 6 Differentiation between Subarachnoid Hemorrhage and Cerebral Hemorrhage | Differentiation Points | Subarachnoid Hemorrhage | Cerebral Hemorrhage | | :--- | :--- | :--- | | Age of Onset | Aneurysms are more common in people aged 40-60 | More common in people aged 50-65 | | Common Causes | Aneurysms, Arteriovenous Malformations | Hypertension, Cerebral Arteriosclerosis | | Onset Speed ​​| Sudden, peak within minutes | Peak within tens of minutes to several hours | | Hypertension | Normal or elevated | Usually significantly elevated | | Headache | Very common, severe | Common, relatively severe | | Coma | Often transient | Persistent coma in severely ill patients | | Focal Signs | Positive meningeal irritation signs | Significant hemiplegia, hemisensory disturbance, and aphasia | | Head CT | High density in cisterns, ventricles, etc. | High density lesions in brain parenchyma | | Cerebrospinal Fluid | Homogeneous and bloody | Meat washing water sample |

Surgical treatment includes aneurysm neck clipping and aneurysm resection. Rehabilitation therapy should begin as early as possible.