Acute Intracerebral Hemorrhage: Recovery and Rehabilitation Insights

Acute intracerebral hemorrhage

Dr.
Tsai, I hope you don’t mind me asking.
My mother suddenly fainted while working, with left-sided movement, tremors, and urinary incontinence.
She was urgently taken to the hospital, where it was immediately discovered that she had a right-sided intracerebral hemorrhage with a volume of 30cc.
After evaluation, the doctors were divided; some recommended surgery while others suggested conservative management.
Ultimately, they decided against surgery and opted for the blood clot to be absorbed naturally.
I am a bit puzzled by this decision.
She has weakness in her left arm and some strength in her legs.
Afterward, she spent 4 days in the intensive care unit and was transferred to a regular ward on the fifth day.
Her consciousness has been clear during these days.
Starting from the sixth day until now, it has been 27 days.
The doctors mentioned that my mother would be able to walk in the future, but she would need rehabilitation for her arm.
Her left hand shows slight movement, and she can lift her left leg upon command.
However, her consciousness fluctuates; sometimes she responds when I tell her not to pull out the nasogastric tube, but she verbally agrees and continues to pull it out.
She has also been experiencing high blood pressure and persistent fever.
Previously, she underwent X-rays and urinalysis, which showed a urinary infection, and she was treated with antibiotics.
Although there was some improvement, she still has a fever.
The doctors later reviewed the X-rays and urinalysis and said everything looked fine, but when I inquired further, they mentioned pneumonia.
I am very worried about my mother’s condition and would like to ask Dr.
Tsai:
1.
For a right-sided brain hemorrhage with a volume of 30cc, will the blood clot completely disappear in about a month through natural absorption?
2.
Is not surgically removing the blood clot likely to cause greater damage to the brain? If so, why?
3.
The doctors were divided in their assessment, with half recommending surgery and half suggesting conservative management.
Is this approach beneficial for the patient?
4.
Does not immediately removing the blood clot result in greater brain damage? If so, why was the decision made not to remove it to minimize brain injury?
5.
With my mother’s acute brain hemorrhage in the right hemisphere, she has slight movement in her left arm and some in her left leg, and her consciousness sometimes responds and sometimes does not.
What areas of function might be affected by a right-sided brain hemorrhage? Will her consciousness and memory be impacted?
Thank you, Dr.
Tsai, for your response, and I appreciate your hard work.

wen, 60~69 year old female. Ask Date: 2020/03/09

Dr. Cai Zongzhang reply Neurology

Hello, I understand that you are very anxious about your mother's condition and are seeking a second medical opinion.
I recommend that you proactively discuss your concerns with your mother's attending physician.
If you have any doubts, you can ask the medical team to provide explanations regarding her condition.

Reply Date: 2020/03/09

More Info

Acute intracerebral hemorrhage (ICH) is a serious medical condition that occurs when there is bleeding within the brain tissue itself. This can lead to significant neurological deficits, depending on the location and extent of the hemorrhage. In your mother's case, the right hemisphere of the brain is affected, which can have specific implications for her recovery and rehabilitation.

1. Recovery of Blood Clot: The absorption of a hematoma (blood clot) can vary significantly from patient to patient. In general, smaller hematomas, like the 30cc in your mother's case, may take several weeks to months to fully resolve. The body has a natural process for reabsorbing blood, but the timeline can depend on factors such as the patient's overall health, age, and the specific characteristics of the hemorrhage. It's not uncommon for patients to experience fluctuations in their neurological status during this period.

2. Surgical Intervention vs. Conservative Management: The decision to operate or to allow the hematoma to resolve on its own is often complex. In some cases, surgery may be necessary if the hematoma is large, causing significant pressure on the brain, or if there are signs of deterioration in the patient's condition. However, if the bleeding is small and the patient is stable, doctors may opt for conservative management, allowing the body to absorb the blood naturally. The concern with not operating is that there may be ongoing bleeding or that the hematoma could expand, leading to increased pressure and potential brain damage. The decision is typically made based on clinical judgment and imaging studies.

3. Impact of Not Removing the Hematoma: Not removing a hematoma does not necessarily mean greater damage will occur, but it does carry risks. If the hematoma is stable and the patient is not deteriorating, conservative management can be appropriate. However, if there are signs of increased intracranial pressure or neurological decline, surgical intervention may become necessary. The medical team must continuously monitor the patient's condition to make the best decisions.

4. Potential Brain Damage: Delaying surgical intervention can lead to complications, but it is not always the case that immediate surgery is required. The brain has a remarkable ability to adapt, and many patients can recover well even after conservative management. However, if there is significant pressure on the brain or if the hematoma is causing other complications, surgery may be warranted to prevent further damage.

5. Effects of Right Hemisphere Damage: Damage to the right side of the brain can affect various functions, including motor control on the left side of the body, spatial awareness, and certain cognitive functions. Patients may experience weakness or paralysis on the left side, as well as difficulties with attention, memory, and emotional regulation. The fluctuations in consciousness and responsiveness you describe may be related to the brain's healing process, and it is not uncommon for patients to have periods of confusion or altered awareness as they recover.

In summary, recovery from acute intracerebral hemorrhage is a complex process that requires careful monitoring and rehabilitation. Your mother's situation is still in the early stages of recovery, and while there are challenges ahead, many patients can make significant progress with appropriate rehabilitation. It is essential to maintain open communication with her healthcare team to understand her specific needs and to adjust her treatment plan as necessary. Rehabilitation will likely focus on physical therapy to improve strength and mobility, as well as occupational and speech therapy to address any cognitive or communicative deficits.

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