Preventing Sudden Cerebral Hemorrhage

The late boxing champ Choi Yo-sam suffered a coma after taking a strong punch to the head, which ruptured a blood vessel.

People might consider sudden traumatic force as something that only happens to boxers, and thus the threat of cerebral hemorrhage can seem distant. This is incorrect. A person with high blood pressure could rupture vessels through suffering stress from an argument. A young non-smoker with diabetes and high blood pressure could also collapse from a stroke.

○ Main Cause: High Blood Pressure

Cerebral hemorrhage often erupts during an argument, fistfight or exercise.

When it happens, a person feels dizzy from the feeling of an empty head, arising from a fissure on the vessel that gushes out blood. Then he or she gradually feels a headache and, in severe cases, vomits or shouts.

Cerebral infarction, more commonly called stroke, occurs when clogged vessels hamper circulation in the brain. Stroke occurs when the blood clots, or thrombosis, chip off on the wall of the vessel and float to the brain, finally clogging the vessels there. Without a supply of new blood, brain cells in the affected area die, causing loss of speech, paralysis or blindness.

High blood pressure is the most frequent cause of stroke. If a person feels stiffness in the back of the neck and suffers from headache under slight stress, he or she should check blood pressure.

Paroxysmal atrial fibrillation is also a major cause of cerebral hemorrhage, since it is due to abnormal pulse patterns like high blood pressure. A PAT patient maintains normal pulse patterns, but could experience an abnormally fast throbbing of the heart for hours without obvious cause. The abnormal throbbing often generates blood clots in the heart, which could shut off blood supply to the brain.

○ Early Signs of Cerebral Hemorrhage

Cerebral hemorrhage sends early warnings to the body. PAT, for instance, gets worse after drinking. Alcohol in the blood raises blood pressure and causes the heart to beat faster.

A transient ischemic attack, or TIA, is a mini or warning stroke. As with other types of hemorrhage-caused disease, a patient can live a normal life. Suddenly, however, he or she might feel numb in the arm or the leg. Other symptoms include speech problems, dizziness or unstable physical posture. A clogged vessel causes TIA as well.

The British medical journal Lancet said in its latest issue that one in 10 TIA patients suffers the same symptoms within one week of the first outbreak. PAT also showed the same pattern, with symptoms popping up more frequently and longer if left untreated. The pattern is similar with stroke.

○ Swift Treatment Critical in Reducing Damage

Doctors call the three hours after the stroke “golden hours,” stressing the importance of time after the rupture. Successful treatment depends on how fast the bleeding is stopped and removal of the blood pool in the brain. When it comes to stroke, blocked circulation must be restarted to minimize damage to brain cells.

Koreans generally render their own diagnosis and decide their own treatment, forfeiting the opportunity to detect disease in the earlier stages. A recent report by the Health and Welfare Ministry on timely detection of cerebral hemorrhage said only 48 percent of patients arrived at the hospital within three hours of the first rupture.

Giving pills to unconscious patients is dangerous, since in most cases, they cannot swallow or could choke on the remaining medicine in the air duct. A patient should also not be shaken or awakened by throwing cold water or slapping.

(Editor’s note: Contributing to the report were Jeong Wu-yeong, cardiologist at Seoul Nat’l University Medical Center in Seongnam, and Hong Geun-shik, neurologist at Inje University Baik Hospital in Ilsan.)

nuk@donga.com