Brain Hemorrhage
Overview
To most people, a “brain Hemorrhage” simply means any bleed inside your head. However, a doctor – and specifically doctors who treat brain Hemorrhage (neurologists and neurosurgeons) – would say that a “brain Hemorrhage” (also known by the medical term intracranial hemorrhage) is too broad of a term. These doctors further describe brain bleeds by their exact location.
To better understand brain bleeds, it’s important to have a basic understanding of the different types. First, there are two main areas where bleeding can occur – bleeding can occur either within the skull but outside of the brain tissue, or inside the brain tissue. These areas are further divided as follows:
Bleeding within the skull but outside of the brain tissue
The brain has three membranes layers (called meninges) that lay between the bony skull and the actual brain tissue. The purpose of the meninges is to cover and protect the brain. Bleeding can occur anywhere between these three membranes. The three membranes are called the dura mater, arachnoid, and pia mater.
● Epidural bleed (hemorrhage): This bleed happens between the skull bone and the outermost membrane layer, the dura mater.
● Subdural bleed (hemorrhage): This bleed happens between the dura mater and the arachnoid membrane.
● Subarachnoid bleed (hemorrhage): This bleed happens between the arachnoid membrane and the pia mater.
Bleeding inside the brain tissue
Two types of brain bleeds can occur inside the brain tissue itself – intracerebral hemorrhage (also called cerebral hemorrhage and hemorrhagic stroke) and intraventricular hemorrhage.
● Intracerebral hemorrhage: This bleeding occurs in the lobes, pons, and cerebellum of the brain (bleeding anywhere within the brain tissue itself including the brainstem).
● Intraventricular hemorrhage: This bleeding occurs in the brain’s ventricles, which are specific areas of the brain (cavities) where cerebrospinal fluid is produced.
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Causes
Bleeding in the brain has a number of causes, including:
● Head trauma, caused by a fall, car accident, sports accident, or another type of blow to the head.
● High blood pressure (hypertension), which can damage the blood vessel walls and cause the blood vessel to leak or burst.
● A buildup of fatty deposits in the arteries (atherosclerosis).
● A blood clot that formed in the brain or traveled to the brain from another part of the body, which damaged the artery and caused it to leak.
● A ruptured cerebral aneurysm (a weak spot in a blood vessel wall that balloons out and bursts).
● A buildup of amyloid protein within the artery walls of the brain (cerebral amyloid angiopathy).
● A leak from abnormally formed connections between arteries and veins (arteriovenous malformation).
● Bleeding disorders or treatment with anticoagulant therapy (blood thinners).
● A brain tumor that presses on brain tissue causing bleeding.
● Smoking, heavy alcohol use, or use of illegal drugs such as cocaine.
● Conditions related to pregnancy or childbirth, including eclampsia, postpartum vasculopathy, or neonatal intraventricular hemorrhage.
● Conditions related to abnormal collagen formation in the blood vessel walls can cause to walls to be weak, resulting in a rupture of the vessel wall.
What are the symptoms of brain bleeds (intracranial hemorrhage)?
Symptoms of a brain hemorrhage depend on the area of the brain involved. In general, symptoms of brain bleeds can include:
● Sudden tingling, weakness, numbness, or paralysis of the face, arm, or leg, particularly on one side of the body.
● Headache. (Sudden, severe "thunderclap" headache occurs with subarachnoid hemorrhage.)
● Nausea and vomiting.
● Confusion.
● Dizziness.
● Seizures.
● Difficulty swallowing.
● Loss of vision or difficulty seeing.
● Loss of balance or coordination.
● Stiff neck and sensitivity to light.
● Abnormal or slurred speech.
● Difficulty reading, writing, or understanding speech.
● Change in level of consciousness or alertness, lack of energy, sleepiness, or coma.
● Trouble breathing and abnormal heart rate (if bleed is located in brainstem).
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Diagnosis
A doctor will examine you immediately if any type of brain hemorrhage is suspected. Diagnosis is usually made based on the results of:
● An evaluation of your physical symptoms.
● Computed tomography (MRI) or magnetic resonance angiogram (MRA) of your brain. These imaging tests determine the location, extent, and sometimes the cause of the bleed.
Other tests may include:
● Electroencephalogram, chest X-ray, and/or urinalysis.
● Complete vascular study, complete blood count (CBC), and/or blood studies.
● Spinal tap to examine the cerebrospinal fluid that surrounds the brain.
● In some cases, conventional angiography may be done to identify an aneurysm arteriovenous malformation.
Treatment
Any type of bleeding inside the skull or brain is a medical emergency. If you or a loved one have experienced a blow to the head or have symptoms that may indicate a brain bleed, call 911. It is important to get to a hospital emergency room immediately to determine the cause of the bleeding and to begin medical treatment.
If a stroke occurred, the cause (bleeding or blood clot) must be determined so that the appropriate treatment can be started. Prompt medical treatment can help limit damage to the brain, which will improve your chance of recovery.
Surgery may be needed in the following situations:
● Bleeding (hemorrhage) may require immediate decompression of the brain to release pooled blood and relieve pressure. Decompression may be done through a burr hole procedure (drilling a hole in the skull to allow blood drainage), a craniectomy incision (partial removal of the skull to allow the swelling brain to expand), or a craniotomy (opening of the skull cavity).
● A cerebral aneurysm that has not ruptured may require clipping or filling (“sealing off”) of the aneurysm through a craniotomy surgical procedure or an angiography-type procedure to prevent a future rupture.
● An arteriovenous malformation (AVM) that has not ruptured is treated by direct removal of the AVM through surgery, use of computer-guided radiation to close off the abnormal vessels, or use of a special glue or other filler to block the blood flow from smaller blood vessels into the AVM or the vessels that supply the AVM.
● Some brain hemorrhages do not require surgery. The decision depends on the size, cause, and location of the bleed, and other factors.
Other treatments may include:
● Anti-anxiety drugs and/or medication to control blood pressure.
● Anti-epileptic drugs for seizure control.
● Other medications are needed to control other symptoms, such as painkillers for severe headaches and stool softeners to prevent constipation and straining during bowel movements.
● Nutrients and fluids as needed. These may be given through a vein (intravenously), or a feeding tube in the stomach (gastronomy tube), especially if the patient has difficulty swallowing.
Rehabilitation
The goals of long-term treatment are to help you regain the functions needed for daily living, as much and as soon as possible, and to prevent future brain hemorrhages. Rehabilitation and recovery time vary according to each person’s unique brain bleed and the extent of rehabilitation possible.
Long-term rehabilitation treatment may include:
● Physical therapy.
● Speech therapy or alternative forms of communication.
● Occupational therapy.
● Changing lifestyle habits to reduce the risk of another hemorrhage. (See next question.)
Prevention
Steps you can take to reduce your risk include:
● Control your blood pressure
● Lowering your cholesterol level
● Lose excess weight
● Limit alcohol and stop smoking.
● Eat a healthy diet.
● Exercise regularly.
● Control blood sugar levels if you have diabetes.
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