A brain hemorrhage refers to bleeding in the brain. Doctors may also refer to it as a brain bleed or an intracranial hemorrhage. A brain hemorrhage is a medical emergency that requires immediate treatment.
Because the firm skull bone encloses the brain with very little space for blood or swelling to expand, a brain hemorrhage squeezes and compresses brain tissue – causing brain damage.
If a blood vessel in the brain leaks or bursts and causes bleeding, it takes blood supply away from the nearby brain tissue, causing a hemorrhagic stroke.
Additionally, compression from excessive bleeding may be so severe that oxygen rich blood is unable to flow to that region of brain tissue. A lack of oxygen in areas of the brain can lead to swelling, or cerebral edema.
Pooled blood from a bleed can also collect into a mass known as a hematoma. The pressure caused by a hematoma can prevent oxygen from reaching nearby brain cells, which can result in death of the oxygen deprived brain cells.
In this article, learn more about brain hemorrhage, its causes, how to recognize when one is occurring, and what to do.
There are
- Intracerebral hemorrhage: This type of bleeding occurs inside the functional tissue of the brain. Doctors may also refer to it as intraparenchymal hemorrhage.
- Subarachnoid hemorrhage: This bleeding occurs in the space between the brain and the membranes that cover it.
- Subdural hemorrhage: This type happens below the inner layer of the dura and above the brain. The dura refers to a layer of connective tissue that make up the meninges (protect membrane) of the brain.
- Epidural hemorrhage: This is when a bleed develops between the skull and the brain.
All types of brain hemorrhage can pose a serious risk to health.
- head trauma or injury
- cerebral aneurysm, or a weakened bulge in a brain artery
- extremely high blood pressure
- blood vessel anomalies
- blood or bleeding disorders
- liver disease
- brain tumor
- recreational drug use
Age
The effects of a brain hemorrhage vary within different age groups. Brain hemorrhages are most likely to occur in older adults.
In infants, a brain hemorrhage can occur due to a birth injury or blunt force trauma to a pregnant person’s abdomen.
Symptoms and some of the treatment options are very similar in adults and children.
A brain bleed can lead to a lack of developmental abilities for young children, such as cerebral palsy. But a brain hemorrhage for an adult causes a decline in abilities that the adult already had, potentially with a long-term disability.
A brain hemorrhage can cause a range of different stroke symptoms. These symptoms may include sudden tingling, weakness, numbness, or paralysis of the face, arm, or leg. This is most likely to occur on one side of the body only.
Other symptoms include:
- sudden, severe headache
- problems with vision
- loss of balance or coordination
- confusion or difficulty understanding
- difficulty talking or slurred speech
- stupor, lethargy, or unconsciousness
- seizures
A brain hemorrhage is a medical emergency, and a person should contact emergency services immediately if they recognise any of the symptoms above.
Complications often arise from a brain hemorrhage. Bleeding, swelling, compression, and lack of blood supply to affected areas of the brain cause immediate symptoms. As the swelling decreases and after treatment, some areas may remain permanently damaged.
Common problems after a brain hemorrhage include movement, speech, or memory issues.
Depending on the location of a hemorrhage and the damage that occurs, some complications may be permanent. These might include:
- paralysis
- numbness or weakness on one side of the body
- difficulty swallowing
- vision loss
- reduced ability to speak or understand words
- confusion or memory loss
- personality change or emotional problems
- epilepsy or recurrent seizures
A brain hemorrhage usually causes very noticeable symptoms and signs, and doctors usually carry out diagnostic testing urgently to help identify the size and location of the bleed and to guide prompt treatment steps.
- Imaging scans: Doctors typically perform a brain CT scan immediately, as it is quick and can easily identify bleeding. They may order an MRI later, when a person is in a more stable condition, because an MRI takes longer than a CT scan.
- Cerebral angiography: During cerebral angiography, a doctor injects a dye into the bloodstream and then takes X-ray images of the brain, with the dye highlighting abnormally shaped blood vessels in or near the brain. A doctor may recommend this method when a person is in a stable condition.
- Lumbar puncture: This is also known as a spinal tap, in which a doctor removes spinal fluid through a hollow needle for testing. Doctors less commonly use this method to diagnose brain hemorrhage.
Surgery
If a burst cerebral aneurysm causes a hemorrhage, a healthcare professional may recommend cerebral angiography with imaging assistance, which is a minimally invasive procedure. In some cases, a surgeon may remove part of the skull and clip the artery. This procedure is called a craniotomy.
Other treatment options include anxiety drugs, antiseizure drugs, and other medications to control symptoms, such as seizures and severe headaches.
Can people recover from a brain hemorrhage?
People can recover from a brain hemorrhage, although it is vital that they receive the correct treatment as soon as possible. Rehabilitation can help an individual adjust to life after a brain hemorrhage.
Rehabilitation treatment includes:
- physical therapy
- speech therapy
- occupational therapy
- lifestyle changes to limit the risk of another hemorrhage
It is important that people protect themselves against the risk of traumatic brain injury. Wearing seatbelts in cars or helmets when riding bikes or motorcycles are easy ways to protect the head and brain.
People who have a brain hemorrhage or a stroke have a 25% chance of another one within 5 years.
The
- regularly monitoring and managing blood pressure
- quitting smoking, if applicable
- managing blood sugar levels, if a person has diabetes
- managing cholesterol levels
- maintaining a healthy weight, which may involve losing weight for some individuals
- eating a heart healthy diet,
such as the DASH diet - regularly exercising
- limiting alcohol intake
People should also make sure to take any medications as instructed by their doctor. They should contact their doctor if they have any concerns about side effects, as the doctor may be able to recommend alternative medications, in some cases.
Individual outlooks
A 2020 study notes that the rate of mortality from intracerebral hemorrhage is
Treatments are always developing and a person’s individual outlook may be more positive than statistics suggest.
Brain hemorrhages are life-threatening and require urgent treatment and extended rehabilitation. Head injuries, certain medical conditions, and recreational drug use can increase the risk of brain hemorrhage.
However, wearing protection during activities that may risk traumatic brain injury, such as cycling, as well as engaging in a healthy, active, smoke-free lifestyle can reduce the risk of a brain hemorrhage.
People should contact their local emergency services immediately if they notice any signs of brain hemorrhage, such as sudden tingling, weakness, numbness, or paralysis of the face, arm, or leg.