Intracerebral bleeding ICB

Admission to the hospital

• Examination and diagnosis

  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.

• Treatment

  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).

• Cerebrospinal fluid drainage

  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.

  Cerebrospinal fluid looks like water and is produced in the cavities in the brain. These cavities are called the “ventricles”. There are two lateral ventricles, a third ventricle in the middle of the brain and a fourth ventricle at the base of the cerebellum. Cerebrospinal fluid is continuously being produced and absorbed. On average, the cerebrospinal fluid is completely refreshed three to four times per day.

  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.