[LifeStyle] Actor Aindrila Sharma ‘critical’ after suffering multiple cardiac arrests following intracranial haemorrhage; is there a link?

[Andy アンディ]

Bengali actor Aindrila Sharma is currently on ventilator support after suffering multiple cardiac arrests on Tuesday, following a brain stroke on November 1. According to Anandabazar.com, the cancer survivor had an intracranial haemorrhage or bleeding within the skull, and had to undergo left frontotemporoparietal de-compressive craniotomy surgery. The actor’s new CT scan reports showed blood clots in her brain, which are on the opposite side of where she was operated on. While doctors have put her on new medicines to subdue the clot, the infection continues to be rather dangerous, the report read. What is an intracranial haemorrhage? According to Dr Sudhir Kumar, a neurologist, intracerebral haemorrhage (ICH) is an “acute event, and happens all of a sudden”. “The most common underlying cause of ICH is hypertension (high blood pressure) and accounts for about 30-35 per cent of all cases of brain stroke. Symptoms of ICH depend on the location of bleeding in the brain,” Dr Kumar toldAgreed Dr Girish B. Navasundi, director of interventional cardiology, Apollo Hospitals, Bengaluru, and said that intracranial haemorrhage, “if associated with increased pressure on the brain or irritability”, can cause sudden cardiac death due to variation in cardiac electrical function. “It happens mostly due to changes in ventricular repolarisation. This means that there is abnormal autonomic control of the heart which, in turn, leads to varying degrees of arrhythmias (abnormal heart rhythm of the heart),” said Dr Navasundi.Common symptoms include headache, vomiting, weakness, numbness or tingling of arm or leg on one side, imbalance while walking, and difficulty in speaking or swallowing. “In severe cases of ICH, a patient may become unconscious and require a mechanical ventilator for breathing support. Some cases of ICH can lead to cardiac arrests also,” noted Dr Kumar.

Can intracranial haemorrhage lead to cardiac arrests?

It can happen in two situations, which Dr Kumar described in detail:

First, if the bleeding occurs in the brainstem (medulla oblongata to be more specific), the breathing and the cardiovascular centre can get affected. This can result in respiratory or cardiac arrest.

Second, if the patient has a large bleed in the cerebral hemispheres, it can cause a mass effect (due to brain swelling) and the cardiovascular centre in the medulla gets compressed, which also results in cardiac arrest. “If prompt cardiopulmonary resuscitation (CPR) is done, the patient may get revived. However, in the above two situations, repeated cardiac arrests may also occur,” said Dr Kumar.Dr Kumar further noted that other causes of ICH are blood thinner medications (such as aspirin, clopidogrel, heparin, etc), bleeding disorders (such as idiopathic thrombocytopenic purpura), severe liver disease, rupture of a cerebral aneurysm (a balloon-like dilatation arising from a brain artery), severe infections and trauma.

Treatment

Dr Madhukar Trivedi, consultant, neurology, Narayana Multispecility Hospital, Jaipur said that the “goal of treatment is to stop the bleeding, remove the clot, and relieve pressure on the brain”. “If left alone, the clot will eventually be absorbed by the brain. The long-term effects of elevated cerebral pressure may be irreversible. To relieve the strain on the skull, decompressive surgery may be required. Drilling a small hole in the skull causes blood to flow. A wider opening or removing a section of the skull may be needed to remove a blood clot,” Dr Trivedi told

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