Acquired Brain Injuries: Hypertensive Brain Hemorrhages

This post was authored by Theresa Neumann and posted to The Eye Opener on July 15th, 2011.

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So what if my blood pressure is high, right? I’m under a lot of stress. I’ll cut back on my caffeine.  I don’t use that much salt.  It’s hot outside.  All reasons to ignore an abnormal blood pressure reading, right?  NOT!

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On the heels of Rachel Leyko’s blog about heat stroke, and in keeping with some topics I’ve been blogging about on acquired brain injuries, hypertensive brain hemorrhages seemed to be a good topic du jour!

Hypertensive brain hemorrhage is just one of the many complications of uncontrolled high blood pressure.  We are currently seeing an epidemic of hypertension, much of it caused by lifestyle and the current epidemic of obesity in the U.S. And, yes, childhood and early adulthood hypertension is on the rise!  In a recent post by MedPage Today, as many as 1 in 5 young adults may have hypertension! The article goes on to cite studies measuring and monitoring patient blood pressures over several years. It is interesting to note that most of the hypertensive individuals did not know that they had high blood pressure! In 2009, DukeHealth.org posted doctor’s advice on managing childhood hypertension, recognizing that the incidence of the condition is on the rise.

Organ Systems Affected by Hypertension

The Mayo Clinic provides an excellent overview of the effects of hypertension on the various organ systems required for bodily functions.  Uncontrolled blood pressure causes damage to the following organs and results in the following conditions:

-Arteries/blood vessels: “hardening of the arteries” and cholesterol-plaque formation leading to stroke, kidney failure, heart attacks, “poor circulation”; aneurysm formation and rupture

-Heart: coronary artery disease (heart attacks); left ventricular hypertrophy and dilated cardiomyopathy; congestive heart failure

-Brain: TIA (transient ischemic attack); stroke (hemorrhagic & ischemic); dementia; mild cognitive dysfunction

-Kidneys: renal failure; renal scarring (leading to failure); renal artery stenosis or aneurysms

I have to admit that one of my “scare tactics” for encouraging patients to treat their hypertension was elaborating on the horrors of hemodialysis; hypertension and diabetes are the two main culprits for patients requiring hemodialysis.  Imagine having to spend 3 days every week hooked up to a dialysis machine (either by a large needle in one’s arm or via a “permanent” catheter tunneled under one’s skin), having to monitor fluid intake, being at increased risk for various infections, and requiring all kinds of specialized drugs to do what the kidneys would normally do! Not fun for anyone! For some reason, this had more effect that the risk of a stroke!

Hypertensive Brain Hemorrhages

I’m going to focus on these types of strokes as opposed to ischemic strokes, knowing that uncontrolled hypertension causes both types.

According to a MedScape Reference Article,

Intracerebral hemorrhage accounts for 8-13% of all strokes and results from a wide spectrum of disorders. Intracerebral hemorrhage is more likely to result in death or major disability than ischemic stroke or subarachnoid hemorrhage. Intracerebral hemorrhage and accompanying edema may disrupt or compress adjacent brain tissue, leading to neurological dysfunction. Substantial displacement of brain parenchyma may cause elevation of intracranial pressure (ICP) and potentially fatal herniation syndromes.

Apparently, over time, the high blood pressures in the arteries and arterioles of the brain causes damage to the inner lining of the walls, making them stiff, weak and less compliant to that pulsation we feel everytime our heart pumps blood throughout the body.  As the pressures inside the vessels exceed the compliance of the vessel walls, ruptures occur, leading to bleeding or hemorrhage into the brain tissue.  The blood can extend into the brain ventricles or into the subarachnoid space, or it can localize and clot within the brain tissue. Not only is the blood flow to brain cells disrupted, but there is now this increased pressure being exerted by the blood collection onto adjacent brain tissue causing even more damage. That brain tissue responds by leaking fluid, causing more brain swelling and increased pressures. It is a bad cascade of events that leads to serious brain injury, permanent neurologic problems and even death.

Watch the following You Tube Animation for both ischemic and hemorrhagic strokes:

httpv://www.youtube.com/watch?v=M_fo6ytlmD0

Some Epidemiologic Statistics

According to the same MedScape article, 350 per every 100,000 elderly individuals sustain hypertensive brain hemorrhages every year in the U.S. The overall mortality rate for general intracerebral hemorrhages is very high, with 20,000 people dying annually in the U.S., 44% of which die within 30 days, and 75% of those with pontine or brainstem hemorrhages dying within 24 hours!

From a race perspective, African Americans have a higher incidence of these brain bleeds due to the higher incidence of hypertension within the population.

Women have a higher incidence of brain aneurysms while men have an overall increased incidence of intracranial hemorrhage (general term includes trauma).

With respect to age,

Incidence of intracerebral hemorrhage increases in individuals older than 55 years and doubles with each decade until age 80 years.

Although the overall incidence of hypertensive brain hemorrhages has decreased between 1950 and 2005 with improved diagnosis and management of hypertension, this trend could change with the increasing incidence of hypertension in the young and lack of diagnosis and treatment; hypertension has historically been a disease of the “middle age” patient.

Medical Diagnosis & Treatment

Time is brain tissue when it comes to any kind of stroke, much like the American Heart Association’s motto regarding Acute Coronary Syndrome, “Time is heart muscle.” In each event, the time from onset of symptoms to diagnosis and treatment is absolutely critical.  In some cases, the severity of the injury might not be amenable to any medical interventions, but then again, a lesser injury can sometimes be treated and managed medically or surgically with a fairly good outcome.  Know the signs and symptoms of stroke (similar for ischemic & hemorrhagic) and do NOT delay in contacting “911″ for rapid transport and medical attention!

SOME RELATED POSTS:

Acquired Brain Injuries: Causes and Impact

Acquired Brain Injuries: Subdural Hematomas

Stroke Warnings:Most People Who Experience Minor Strokes Do Not Recognize Its Symptoms\

Image courtesy of “Baxters Blog”.

 

 

 

 

 

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