Cerebral hemorrhages (Brain bleeds)

Cerebral hemorrhage is one of the most feared conditions in the brain, but not all hemorrhages are created equal. Some are minor and not life threatening; others are disabling or even fatal.

In this series of posts, I will discuss different types of hemorrhages.
There are several categories of brain hemorrhages. Each of them has its own management, thus it is important to differentiate between those categories.

As the name implies, this hemorrhage is typically related to chronically elevated blood pressure, which causes structural changes in the small and thin brain vessels (perforating vessels) creating a very fragile vessel wall.
There are certain areas that are more frequently involved: basal ganglia, cerebellum and brain stem. Cortical hemorrhages may also happen, but it is less likely.
Although those hemorrhages are more frequent in the elderly, I saw a number of young patients who were not aware of having severe hypertension before their bleed.
Prevention for those hemorrhages is good blood pressure control and very regular checkups. If a patient has a hemorrhage, I typically take measurements upon awakening and at about 6-7 pm. I strongly recommend keeping a log.

More common in patients with advanced age, although some patients with genetic form may develop it earlier in life. It is caused by deposition of protein called amyloid in the perforating arteries, mostly in the cortical region. Hemorrhages in cortical (superficial) regions are seen in most cases. Deposits of amyloid in brain cells (neurons) cause Alzheimer dementia. Unfortunately, both conditions can coexist in a patient due to similar etiology. Those hemorrhages are recurrent, rather large, and may occur in patients with normal blood pressure.
I use certain medications to prevent those hemorrhages and that strategy seem to be effective in my experience.