Brain Hemorrhage

What Is a Brain Bleed or Brain Hemorrhage?

A brain hemorrhage is a type of stroke that results from the leaking or rupturing of a blood vessel in the brain. Brain hemorrhages are also known as intracranial hemorrhages, intracerebral hemorrhages, cerebral hemorrhages, or brain bleeds. They commonly occur after you fall or experience a traumatic brain injury.

If you or someone else is experiencing one, you should seek emergency care immediately.

What Happens During a Brain Hemorrhage?

A brain hemorrhage can cause serious damage to the impacted area. A hematoma (or the pooling of clotted blood that forms in an organ, tissue, or body space) can form within your skull and brain, inhibiting blood flow to the brain cells. This prevents the brain cells and region from receiving vital oxygen and nutrients that sustain life, leading to the death of these cells and changes in the functions they control. This is a serious and even life-threatening event.

Types of Brain Bleeds

Brain hemorrhage is a broad term that encompasses subtypes. Brain hemorrhage classifications are based on their location in the brain, either within the skull but outside of the brain tissue or inside the brain tissue. There are four types of brain hemorrhages:

• Epidural hemorrhage
• Subdural hemorrhage
• Subarachnoid hemorrhage
• Intraparenchymal hemorrhage

The brain has three membrane layers, or meninges, between the skull bone and brain tissue. The three membranes are the dura mater (beneath the skull bone), arachnoid (middle layer), and pia mater (closest to the brain). These membranes cover and protect the brain. Where the blood is located will determine the type of brain hemorrhage.

• Epidural hemorrhage refers to bleeding between the skull bone and the dura mater.
• Subdural hemorrhage refers to bleeding between the dura mater and the arachnoid membrane.
• Subarachnoid hemorrhage refers to bleeding between the arachnoid membrane and the pia mater.

The brain consists of brain tissue and ventricles (or cavities in the brain that produce and store cerebrospinal fluid). Bleeding can occur in these regions as well.

• Intracerebral hemorrhage refers to bleeding inside the brain itself.
• Intraventricular hemorrhage refers to bleeding in the brain’s ventricles.

The type of hemorrhage will have distinct causes, prognosis, and health outcomes.

Signs & Symptoms of a Brain Bleed

When a brain injury causes a brain bleed, the pooled blood can alter the brain region’s structure and function. These changes can lead to you experiencing signs or symptoms that can include the following:

• Sudden, severe, and painful headache
• Vomiting and nausea
• Confusion
• Dizziness
• Blurred or double vision
• Loss of vision
• Seizures
• Sensitivity to light
• Stiff neck
• Slurred speech
• Loss of coordination
• Loss of consciousness
• Changes in motor function
• Sleepiness or drowsiness
• Changes in breathing

Brain bleeds are serious injuries. You should seek medical attention immediately if you suspect you have a brain bleed.

What Causes a Brain Hemorrhage?

A brain hemorrhage can occur from the following:

• A brain injury event (such as a fall, sports injury, or car accident)
• Atherosclerosis (a buildup of fatty deposits in your arteries)
• Cerebral aneurysm
• Blood clot
• Brain tumor
• Arteriovenous malformation
• Cerebral amyloid angiopathy
• Infections

The region of the brain that has been affected will determine what brain functions are impacted.

Who Is at Risk for Brain Hemorrhages?

Anyone is at risk of a brain hemorrhage. However, people over 65 may experience them more frequently due to changes in their mobility, which can lead to falls.  You might also be at risk for developing a brain bleed if you experience any of the following:

• Hypertension or high blood pressure
• Substance use disorder
• Bleeding conditions or use anticoagulants (or blood thinners)
• Pregnancy or childbirth-related conditions
• Disorders or diseases that affect the development of your blood vessels

If you ever have a head injury and have one of these conditions, seek medical attention as soon as possible.

Treatment

When you seek medical attention for a suspected brain hemorrhage, you will take a physical exam, neurological exam, and testing.

Depending on the results, you might have to take an imaging test, such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or magnetic resonance angiogram (MRA), that will provide more information to the clinician administering your care. Taken together, these will influence your treatment options.

Treatments for brain hemorrhages will differ based on their size and location—between the skull bone and brain or within the brain itself. For hemorrhages within the brain, treatment options are more conservative and comprehensive. Immediate attention is necessary for all brain hemorrhages, regardless of location.

Surgical and non-surgical treatments for brain hemorrhages include:

• Epidural hemorrhage treatments aim to surgically (e.g., decompression, craniectomy, or craniotomy) remove the hematoma and stop the source of the bleeding.
• Subdural hemorrhage treatments aim to remove the hematoma and stop the bleeding surgically or non-surgically (includes burr hole craniostomy, endovascular treatment with middle meningeal artery (MMA) embolization with chronic SDH, repeated imaging, anticoagulation reversal, or even platelet transfusion).
• Subarachnoid hemorrhage treatments aim to use non-surgical options like the subdural localized brain bleed and monitoring for brain swelling.

Treatment options also include medications, supplemental oxygen via a ventilator, intravenous nutrients and fluids, and close monitoring of vitals to ensure a stable condition.

Remember that brain hemorrhages are life-threatening events, and the treatment options come with potential risks and complications.

Complications

A brain hemorrhage is a serious event that can lead to permanent brain damage or even death if not treated immediately. The lack of nutrients and oxygen will result in the death of the impacted brain cells and region. This will interrupt the brain functions that the impacted cells/region control throughout your body, leading to immediate and long-lasting complications to your brain functioning.

Some potential immediate complications for untreated brain hemorrhage are:

• Changes in your memory
• Changes to your coordination/movement
• Changes to your senses
• Changes to your speech
• Changes to your emotions

Some potential long-lasting complications include:

• Permanent brain damage
• Coma
• Seizures
• Increased blood pressure
• Fever
• Infections
• Paralysis
• Death

Recovery

The road to recovery from a brain hemorrhage will depend on its size, location, duration, and eventual treatment options.

If the affected brain region is involved in your cognitive, motor, emotional, or sensory functions, you might need to undergo rehabilitation treatment such as physical therapy, speech therapy, occupational therapy, and lifestyle changes to prevent future brain hemorrhage.

Can Brain Hemorrhages Be Prevented?

While there is no way to guarantee you’ll never experience a brain hemorrhage, preventative measures can be taken to mitigate the risk.

For external prevention, prevent head injuries by wearing the appropriate protective gear for your activities, using protective restraints in moving vehicles, and moving obstacles from frequented pathways to prevent trips or falls.

Consider changes to your diet, exercise, and lifestyle for internal prevention.

Brain Hemorrhage Fundamentals

As the brain is a complex organ with many layers, the size and location of the brain hemorrhage will determine the potential treatment options. Recovery from a brain hemorrhage may require rehabilitation, which will be dependent on the brain region affected, the functions the region controls, and the duration of the event.