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Symptoms include: acute severe headache, nausea, neurological loss of function, epilepsy and reduced consciousness or loss of consciousness.
The course and prognosis of the hemorrhage depend strongly on the cause and the severity.
Admission to the hospital
When an AVM hemorrhages, this can cause an intracerebral bleed. You will be admitted urgently for the treatment of the consequences of the hemorrhage. read moreAdmission to the hospital
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If you are admitted to the hospital, because we think that you have suffered a cerebral hemorrhage, then we will first perform a CT scan (Computer Tomography) of the brain. This scan allows us to see what type of cerebral hemorrhage you have had. The blood vessels can be made visible in the CT scan by injecting contrast fluid via an infusion line in your arm, so that we can detect any vascular abnormality. Often a cause is not found on a CT scan of the brain vessels.
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If you have developed increased pressure on the brain as a result of the hemorrhage, then the neurosurgeon will consider inserting a drain and a pressure meter through the skull and into a ventricle in the brain. This will allow cerebrospinal fluid to drain away and reduce the pressure on the brain. The pressure on the brain can also be measured. You will be admitted to the Intensive Care Unit or the Medium Care Unit.
If the hemorrhage takes up a lot of space and compresses the brain, we can consider surgical removal of the blood. If extreme swelling of the brain occurs, a part of the skull can be removed for the period that the brain is swollen. The missing part of the skull can be repositioned after three months, once you have recovered sufficiently. You will wear a helmet to protect your brain during the recovery period.
The intensive care physician and the neurosurgeon will discuss the treatment plan with your contact person.
If there is any doubt about the cause of the hemorrhage, then the team of vascular specialists may decide to perform further examinations. This will involve further examination of the blood vessels (angiogram). -
The brain and the spinal cord are surrounded by cerebrospinal fluid (liquor). The cerebrospinal fluid has various important functions, namely:
- Protecting the brain. The brain is surrounded by the cerebrospinal fluid and therefore cannot touch the skull. The cerebrospinal fluid also protects us against poisonous substances in the blood.
- Passing on information from the brain to other cells in our body.
Why insert a drain?
If there is a problem with the circulation of the cerebrospinal fluid, then the fluid can accumulate in the brain. An accumulation of cerebrospinal fluid causes increased pressure in the brain. This can disrupt the functioning of the brain and cause brain damage. When cerebrospinal fluid accumulates in the brain, we need to do something to limit the damage as much as possible.The treatment
External ventricle drain
An external ventricle drain (EVD) is a thin tube (drain) that is inserted surgically in the ventricle via your skull. During the surgery, the neurosurgeon makes a small incision in your skin. The neurosurgeon will make a hole measuring approximately 1 cm in diameter in the skull. A section of the drain tube is then inserted in the ventricle. The skin is then closed, and the drain tube is fixed in position by means of a suture or a plaster.
The collection system for the drain will be attached to your bed and you will be on bed rest. The doctor will determine the level at which the collection system will be attached.Ventriculo-Peritoneal drain (VP-drain)
If the absorption of cerebrospinal fluid is a problem for a longer period, then a Ventriculo-Peritoneal drain (VP-drain) is an option. This drain helps to remove the cerebrospinal fluid. The drain is a tube that the doctor inserts in the ventricle. The drain runs internally to your abdomen, where it is coiled up. The drain has a pressure relief valve. This valve is located under the scalp and can be felt above the right ear. It ensures that cerebrospinal fluid is removed via the drain to the abdomen if the pressure in the head becomes too high. The draining of cerebrospinal fluid will stop once the pressure in your head returns to normal. Surgery is required to insert this drain. It is a fairly simple procedure. The doctor will drill a hole on the right side of the skull. The doctor will insert the drain into the ventricle via this hole and push the tube under the skin towards the abdominal cavity. The operation will take approximately one hour.Complications
There is a risk of complications with any surgical procedure. The most common complication with a VP drain is an infection, or the inadequate functioning of the drain. The neurosurgeon will discuss the potential complications of this surgery with you.
Complications
Complications after an intracerebral bleeding can be very different en are dependent on the size and the location of the bleeding. Here we explain the most common complications. read moreComplications
Discharge from the hospital
The medical-technical treatment by the neurosurgeon will gradually decrease during the time spent on the nursing ward. The focus of your admission will switch to rehabilitation. read moreDischarge from the hospital
The medical-technical treatment by the neurosurgeon will gradually decrease during the time spent on the nursing ward. The focus of your admission will switch to rehabilitation.
During your recovery, you will be given advice from your treatment team about where you can recover after the hospital admission.
Discharge to home
If you are able to perform daily tasks independently and safely, then you can be discharged to home. Your family or relatives can collect you at the agreed time. If you require further therapy at home, then you will be referred to — for example — a physical therapy or occupational therapy practice. If you require care at home, the nurse will complete an application for home nursing care. An expert from the Centrum Indicatiestelling Zorg (CIZ) [Healthcare Indication Center] will give you advice about the care that you require at home.You may notice after some time that you continue to experience problems with fatigue, processing of stimuli, concentration or memory. This will be discussed during the follow-up appointments and if necessary you will be referred to a rehabilitation center for day treatment.
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Rehabilitation in a rehabilitation center
For you to receive rehabilitation treatment in a rehabilitation center (Specialized Medical Rehabilitation), you must have the capacity to undergo the treatment and there must be a prospect of future discharge to the home situation. If you are selected for this form of rehabilitation, then the rehabilitation physician will enroll you. After completing the neurosurgical treatment, you may be transferred to the peripheral hospital where you were originally admitted during the waiting time for a place in the rehabilitation center.
Rehabilitation in a nursing home
If your capacity to undergo treatment is limited to such an extent that you need to rest a lot in between treatments and you do have the prospect of being discharged to the home situation in the future, then you can opt for Geriatric Rehabilitation Care (GRC) in a nursing home. After completing the neurosurgical treatment, you may be transferred to the peripheral hospital where you were originally admitted during the waiting time for a place in the nursing home. The Care Transfer Point will support you in selecting one of the nursing homes where GRC is possible and will arrange the registration.
Rehabilitation for a longer period in a nursing home
If you still require a lot of support during daily activities and it is not certain whether discharge to the home situation is an option for you, then a prolonged stay in a nursing home with rehabilitation is an option (indication 9b). You will have a longer period available in which you can work on your recovery and discharge to the home situation if possible. After completing the neurosurgical treatment, you may be transferred to the peripheral hospital where you were originally admitted during the waiting time for a place in the nursing home. The Care Transfer Point will support you in selecting one of the nursing homes where a stay with indication 9b is possible.
Early Intensive Neuro-rehabilitation (EIN)
EIN is an intensive rehabilitation program for patients who have suffered severe brain damage and are in a state of reduced consciousness as a result. The EIN program can contribute significantly to recovering consciousness. There are only a few centers in the Netherlands where this program is available. In the southern part of the Netherlands this is available via Libranet, rehabilitation center “Het Leijpark” in Tilburg. The indication is set by the rehabilitation physicians of the institution.Prolonged stay in a nursing home
If the care staff take over most of your personal care and you are not expected to recover to such an extent that you can be discharged to the home situation, then admission for a prolonged stay is the obvious choice. Experience teaches us that this is rare in younger patients following a cerebral hemorrhage. After completing the neurosurgical treatment, you may be transferred to the peripheral hospital where you were originally admitted during the waiting time for a place in the nursing home. The Care Transfer Point will support you in selecting one of the nursing homes where a prolonged stay is possible.
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If you have been discharged and you do not require any nursing care during the journey, then your loved ones can collect you from the nursing ward.
If you are being transferred to another facility and you require nursing care during the journey, then the nurse on the ward will arrange your transport by ambulance.
The nurse will give the medical and nursing discharge papers to the EMT. Your family physician will receive a note explaining which treatment you have received. -
There are no strict limitations about what you can do after being discharged from the hospital, but you will notice that you cannot resume all activities immediately without causing your symptoms to worsen.
Often the symptoms will worsen after returning home, because you will be more active and there will be more stimuli from the environment than was the case in the hospital. Even the car journey home can cause symptoms, because everything whizzes past at speed. The visits, phone calls and your own attempts to resume chores at home can also exacerbate your symptoms.
Common symptoms following excessive stimuli are:- headache or pressure on the head
- fatigue, physical or mental
- drowsiness or difficulty falling asleep
- nausea, vomiting
- dizziness and balance problems
- hypersensitivity to activity, light or sounds
- irritable or emotional reactions to your surroundings
Tips to limit symptoms
- Increase your activities gradually. If the symptoms increase, then this is a sign that you should slow down a little.
- Create a regular and repetitive daily routine in which you alternate activity and rest. Do not let your moments of rest be dependent on your developing symptoms.
- Try to do one thing at a time. For example, switch off the radio or television in the background and put your cellphone away and only check it at set times each day.
- When you perform an activity for the first time, do this in a way that allows you to have control over the situation and stop if you want to. For example, doing the shopping or riding a bicycle. Take someone with you who can help you if it becomes too much.
- Always carry sunglasses and earplugs in your bag to use when you encounter unexpected environmental stimuli.
- Try not to do everything in one day. This is a trap that many people fall into on a good day and often results in a “harmonica effect” in which you suffer a setback in the following days.
- Schedule strenuous activities — or activities for which you need to be fit — in the morning when your energy levels are highest.
- Schedule adequate recovery time after strenuous activities. For example, ensure that you can take it easy the day after a birthday party.
- Avoid time pressure. Do not be tempted to finish a task quickly. Do not set any deadlines for yourself about when you should have recovered to perform an activity.
- Tell those around you what your limits are and explain to them that you cannot do everything the way you used to. If you find that explaining this often takes a lot of energy, you could send friends and family a message to explain this.
- Your symptoms can actually get worse if you do not exercise enough (for fear of making your symptoms worse). Try to get some gentle physical exercise on a daily basis, for example go for a walk or ride a bicycle if possible.