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Cerebral hemorrhage
Classification and external resources
Cerebral hemorrhage
ICD-10	I61, P10.1
ICD-9	431
MeSH	D002543

A cerebral hemorrhage or haemorrhage (or intracerebral hemorrhage, ICH) is a subtype of intracranial hemorrhage that occurs within the brain tissue itself. Intracerebral hemorrhage can be caused by brain trauma, or it can occur spontaneously in hemorrhagic stroke. Non-traumatic intracerebral hemorrhage is a spontaneous bleeding into the brain tissue.^[1]

A cerebral hemorrhage is an intra-axial hemorrhage; that is, it occurs within the brain tissue rather than outside of it. The other category of intracranial hemorrhage is extra-axial hemorrhage, such as epidural, subdural, and subarachnoid hematomas, which all occur within the skull but outside of the brain tissue. There are two main kinds of intra-axial hemorrhages: intraparenchymal hemorrhage and intraventricular hemorrhages. As with other types of hemorrhages within the skull, intraparenchymal bleeds are a serious medical emergency because they can increase intracranial pressure, which if left untreated can lead to coma and death. The mortality rate for intraparenchymal bleeds is over 40%.^[2]

Signs and symptoms[link]

Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed.^[3] Other symptoms include those that indicate a rise in intracranial pressure due to a large mass putting pressure on the brain.^[3] Intracerebral hemorrhages are often misdiagnosed as subarachnoid hemorrhages due to the similarity in symptoms and signs. A severe headache followed by vomiting is one of the more common symptoms of intracerebral hemorrhage. Some patients may also go into a coma before the bleed is noticed.

Causes[link]

CT scan showing hemorrhage in the posterior fossa^[1]

Intracerebral bleeds are the second most common cause of stroke, accounting for 30–60% of hospital admissions for stroke.^[1] High blood pressure raises the risks of spontaneous intracerebral hemorrhage by two to six times.^[1] More common in adults than in children, intraparenchymal bleeds are usually due to penetrating head trauma, but can also be due to depressed skull fractures. Acceleration-deceleration trauma,^[4][5][6] rupture of an aneurysm or arteriovenous malformation (AVM), and bleeding within a tumor are additional causes. Amyloid angiopathy is a not uncommon cause of intracerebral hemorrhage in patients over the age of 55. A very small proportion is due to cerebral venous sinus thrombosis. Infection with the k serotype of Streptococcus mutans may also be a risk factor, due to its prevalence in stroke patients and production of collagen-binding protein.^[7]

Risk factors for ICH include:^[8]

• Hypertension
• Diabetes
• Menopause
• Current cigarette smoking
• Alcoholic drinks (≥2/day)

Tramautic intracerebral Hematomas are divided into acute and delayed. Acute intracerebral Hematomas occur at the time of the injury while delayed intracerebral Hematomas have been reported from as early as 6 hours post injury to as long as several weeks. It is important to keep in mind that intracerebral Hematomas can be delayed because if symptoms begin to appear several weeks after the injury, concussion is no longer considered and the symptoms may not be connected to the injury.

Diagnosis[link]

Spontaneous ICH with hydrocephalus on CT scan^[1]

Intraparenchymal hemorrhage can be recognized on CT scans because blood appears brighter than other tissue and is separated from the inner table of the skull by brain tissue. The tissue surrounding a bleed is often less dense than the rest of the brain due to edema, and therefore shows up darker on the CT scan.

Treatment[link]

Treatment depends substantially of the type of ICH. Rapid CT scan and other diagnostic measures are used to determine proper treatment, which may include both medication and surgery.

Medication[link]

• Antihypertensive therapy in acute phases. The AHA/ASA and EUSI guidelines (American Heart Association/American Stroke Association guidelines and the European Stroke Initiative guidelines) have recommended antihypertensive therapy to stabilize the mean arterial pressure at 110 mmHg. One paper showed the efficacy of this antihypertensive therapy without worsening outcome in patients of hypertensive intracerebral hemorrhage within 3 hours onset.^[9]
• Giving Factor VIIa within 4 hours limits the bleeding and formation of a hematoma. However, it also increases the risk of thromboembolism.^[10]
• Mannitol is effective in acutely reducing raised intracranial pressure.
• Acetaminophen may be needed to avoid hyperthermia, and to relieve headache.^[10]
• Frozen plasma, vitamin K, protamine, or platelet transfusions are given in case of a coagulopathy.^[10]
• Fosphenytoin or other anticonvulsant is given in case of seizures or lobar hemorrhage.^[10]
• H2 antagonists or proton pump inhibitors are commonly given for stress ulcer prophylaxis, a condition somehow linked with ICH.^[10]
• Corticosteroids, in concert with antihypertensives, reduces swelling.^[11]

Surgery[link]

Surgery is required if the hematoma is greater than 3 cm (1 in), if there is a structural vascular lesion or lobar hemorrhage in a young patient.^[10]

• A catheter may be passed into the brain vasculature to close off or dilate blood vessels, avoiding invasive surgical procedures.^[12]
• Aspiration by stereotactic surgery or endoscopic drainage may be used in basal ganglia hemorrhages, although successful reports are limited.^[10]

Other treatment[link]

• Tracheal intubation is indicated in patients with decreased level of consciousness or other risk of airway obstruction.^[10]
• IV fluids are given to maintain fluid balance, using normotonic rather than hypotonic fluids.^[10]

Prognosis[link]

The risk of death from an intraparenchymal bleed in traumatic brain injury is especially high when the injury occurs in the brain stem.^[2] Intraparenchymal bleeds within the medulla oblongata are almost always fatal, because they cause damage to cranial nerve X, the vagus nerve, which plays an important role in blood circulation and breathing.^[4] This kind of hemorrhage can also occur in the cortex or subcortical areas, usually in the frontal or temporal lobes when due to head injury, and sometimes in the cerebellum.^[4][13]

For spontaneous ICH seen on CT scan, the death rate (mortality) is 34–50% by 30 days after the insult,^[1] and half of the deaths occur in the first 2 days.^[14]

The inflammatory response triggered by stroke has been viewed as harmful in the early stage, focusing on blood-borne leukocytes, neutrophils and macrophages, and resident microglia and astrocytes.^[15] New area of interest are the Mast Cells.^[16]

Epidemiology[link]

It accounts for 20% of all cases of cerebrovascular disease in the US, behind cerebral thrombosis (40%) and cerebral embolism (30%).^[17]

It is two or more times more prevalent in African-American patients than it is in white.^[18]

References[link]

External links[link]

• Parent friendly information on IVH in premature babies from The Hospital for Sick Children
• LPCH on Intraventricular
• Information on brain haemorrhage from Headway - the brain injury association UK based charity providing information and support

Jagjit Singh
Jagjit Singh performing at Jaidev Hall, Bhubaneswar, on 7 September 2011
Background information
Birth name	Jagmohan Singh
Born	(1941-02-08)8 February 1941 Sri Ganganagar, Bikaner State, India
Died	10 October 2011(2011-10-10) (aged 70) Mumbai, Maharashtra, India
Genres	Ghazal, Classical, Devotional, Folk
Occupations	Composer, Singer, Music Director, Activist, Entrepreneur
Instruments	Vocals, Harmonium, Tanpura, Piano
Years active	1965–2011
Labels	EMI, HMV, Saregama, Universal Music, Sony BMG Music Entertainment, Polydor, TIPS, Venus, T-Series, Magna Sound, Big Music, Times Music

Jagjit Singh, born Jagmohan Singh); (8 February 1941 – 10 October 2011) was a prominent Indian Ghazal singer, songwriter and musician. Known as "the Ghazal King", he gained acclaim together with his wife, another renowned Indian Ghazal singer Chitra Singh in the 1970s and 1980s. Their combination album comprising music from the films, Arth and Saath Saath is the HMV's largest selling combination album of all time.^{[citation needed]} Sajda (An Offering, 1991), Jagjit Singh's magnum opus double album with Lata Mangeshkar holds the same record in non-film category.^{[citation needed]} He had sung in numerous languages. He was awarded the Padma Bhushan by the government of India in 2003.

Singh is credited for the revival and popularity of ghazal, an Indian classical art form, by choosing poetry that was relevant to the masses and composing them in a way that laid more emphasis on the meaning of words and melody evoked by them. In terms of Indian Classical music, his style of composing and Gayaki (singing) is considered as Bol-pradhan, one that lays emphasis on words. He highlighted this in his music for films such as Prem Geet (1981), Arth and Saath Saath (1982), and TV serials Mirza Ghalib (1988) and Kahkashan (1991). Jagjit Singh is considered to be the most successful ghazal singer and composer of all time in terms of both critical acclaim and commercial success. With a career spanning over five decades and a repertoire comprising over 80 albums,^[1] the range and breadth of his work has been regarded as genre-defining. He is the only composer and singer to have composed and recorded songs written by Prime Minister - Atal Behari Vajpayee - also a critically acclaimed poet - in two albums, Nayi Disha (1999) and Samvedna (2002).

Singh's 1987 album, Beyond Time, was the first digitally recorded release in India.^{[citation needed]} He was regarded as one of India's most influential artistes. Together with sitar legend Ravi Shankar and other leading figures of Indian classical music and literature, Singh voiced his concerns over politicisation of arts and culture in India and lack of support experienced by the practitioners of India's traditional art forms, particularly folk artists and musicians. He also lent active support to several philanthropic endeavors such as the library at St. Mary's School, Mumbai, Bombay Hospital, CRY, Save the Children and ALMA.

Early life and career[link]

Jagjit Singh was born on 8 February 1941 in Sri Ganganagar, Rajasthan, India. His birth name was Jagmohan but this was changed to Jagjit after his parents sought the advice of a member of the Sikh Namdhari sect.^[2] His parents were themselves Sikhs, called Amar Singh and Bachan Kaur, and had several other children, with sources variously reporting the number between six and eleven.^[3][4]

Educated initially at Khalsa High School and Sri Ganganagar Government College, Singh obtained an arts degree from DAV College at Jalandhar and then a post-graduate degree in history from Kurukshetra University in Haryana. Throughout this time, and as a consequence of a natural talent that was spotted by his father, Singh learned music both in Sikh temples and from musicians such as Pandit Chaganlal Sharma and Ustad Jamaal Khan, both of whom were trained in classical Indian music. He performed on radio and on stage, as well as composing some material, although he subsequently claimed that his father, who was a government employee, had hoped that he would become an engineer.^[5] On another occasion his memory was that his father aspired for him to become a bureaucrat, and that his siblings also were encouraged musically.^[3]

In March 1965, and without the knowledge of his family,^[5] Singh moved to Mumbai, where there were many opportunities for music artists because of the Bollywood film industry. He obtained work initially as a singer of advertising jingles and later progressed to playback singing.^[2] In the same year he persuaded the record company HMV to produce an EP, and he also altered his Sikh image by abandoning his turban, shaving and cutting his hair.^[5] His first film role was in Dharati Na Chhoru, a Gujarati production by Suresh Amin.^{[citation needed]}

Fame[link]

Singh was still struggling to make a living in 1967 when he met the Bengali-born Chitra Dutta.^[5] She was also a jingle singer, and was unhappily married with a daughter. She subsequently divorced and then married Singh in December 1969.^[3] Following the birth of their son, Vivek, the couple performed as a singing duo but it was not until the 1976^{[clarification needed]} release of an album entitled The Unforgettables that they found significant, and surprising, success. In the interval, the primary difficulty for them had been that the ghazal music genre was dominated by Muslim artists,^[5] and especially those from Pakistan.^[6]

The Unforgettables, which was the couple's first LP,^[3] was an unconventional recording and it turned them into stars. The song Baat Niklegi from the album achieved great popularity for Singh and his wife.^[4] The Independent described it in 2011 as "ground-breaking ... it became a transformative, before-and-after milestone in the history of Indian popular and ghazal music. It remains that." Using modern arrangements, it consists of ten tracks that include two on which they sang as a duo and the remainder equally split between Jagjit and Chitra singing the lead. The Independent further noted that "This format of solo and duet performances from the first commercially successful husband-and-wife team in Indian popular music proved astonishingly successful."^[2] Jagjit explained that "I was determined to polish up the genre and make it more acceptable to modern tastes, so chose simple poems and set them to simple tunes. I also introduced western instrumentation to make them livelier." Thereafter, the couple worked both on solo and joint musical projects and performed concerts worldwide. There was also success from involvement with the film industry and they amassed a considerable wealth,^[5] while Jagjit became known as "the Ghazal king".^[6]

Jagjit Singh's work in film^[7] encompassed playback singing for productions such as Arth, Saath Saath and Premgeet. He also composed all of the songs for the latter, as well as for the TV serial Mirza Ghalib that was based on the life of the eponymous poet, Mirza Ghalib.^{[citation needed]}

Among their subsequent duo recordings of the 1970s were Shiv Kumar Batalvi – Birha da Sultan (1978), Live in Concert at Wembley (1979) and Come Alive (1979). Of those released in the 1980s, Ecstasies (1984) has been described as "one of their finest".^[2] The joint projects ceased in 1990 when their eighteen year-old son, Vivek, was killed in a road accident. Chitra felt unable to sing following these events. Monica, Chitra's daughter from her first marriage, committed suicide in 2009.^[2][5]

Although Jagjit continued to work and to have success after Chitra withdrew from public life he, too, was affected by the death of Vivek. The Guardian notes that he "suffered from deep depression and his anguish was often evident in his live performances." Aside from occupying himself with solo projects, which he performed in several languages,^[6] he also collaborated with Lata Mangeshkar on an album entitled Sajda, an Urdu word meaning "prostration".^[2][5]

On 10 May 2007, in the presence of numerous political and diplomatic luminaries at an event held in the Central Hall of the Parliament of India, Jagjit Singh rendered Bahadur Shah Zafar's famous ghazal Lagta nahin hai dil mera to commemorate the 150th anniversary of the Indian Rebellion of 1857.^[4][8]

Death[link]

Singh toured the UK in 2011 and was due to perform with Ghulam Ali in Mumbai^[5] but suffered a cerebral hemorrhage on 23 September 2011. He was in a coma for over two weeks and died on 10 October 2011 at Lilavati Hospital, in Mumbai. He was cremated the following day at Chandanwadi Crematorium in Mumbai.^[9][10]

A number of tributes have been paid to Singh after his death,^{[11][12][13][14][15]} and some tried to encash his popularity which was criticised by his wife.^[16]

Awards[link]

• In 2003, Singh was awarded the Padma Bhushan, India's third highest civilian award, by the Government of India^[5]
• In 1998, Jagjit Singh was awarded Sahitya Academy Award, a literary honor in India. He was awarded this literary honor for popularizing the work of Mirza Ghalib.
• Sangeet Natak Academy Award
• Sahitya Kala Academy Award by Rajasthan Government in 1998
• Ghalib Academy by Delhi Government in 2005
• Dayavati Modi Award
• Lata Mangeshkar Samman in 1998 by Madhya Pradesh Government
• D. Litt. by Kurukshetra University, Haryana in 2003
• Teacher's Lifetime Achievement Award in 2006

Film scores[link]

Discography[link]

References[link]

External links[link]

• Jagjit Singh on BBC
• 'Ghazal King' Jagjit Singh dies, BBC
• Jagjit Singh at Internet Movie Database

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