What Is a Brain Hemorrhage?
A brain hemorrhage is a type of stroke. It happens when a weakened blood vessel in your brain starts to leak or suddenly bursts. As a result, your brain cells can't get enough oxygen and nutrients. That can severely damage them.
Brain hemorrhages are also called cerebral hemorrhages, intracranial hemorrhages, intracerebral hemorrhages, hemorrhagic strokes, or brain bleeds. They account for about 13% of all strokes.
Since brain hemorrhages can be disabling or life-threatening, it’s crucial to get medical help fast if you think you or someone else is having one.
What Happens During a Brain Hemorrhage?
Your brain isn't a muscle. It's a complex organ that contains a finely tuned network of both nerves and blood vessels. But sometimes, one or more of these blood vessels can become weak from damage or even burst.
Once blood begins leaking out of a vessel, it can irritate the surrounding brain tissue and cause swelling. This is known as cerebral edema. The pooled blood collects into a mass called a hematoma. Your skull does a good job of protecting your brain by keeping it tightly contained. There's not a lot of space between your brain and skull. But that means conditions like these can quickly increase pressure on your brain, which reduces vital blood flow and can damage brain cells.
Bleeding can occur inside your brain, between your brain and the membranes that cover it, between the layers of your brain's covering, or between your skull and the covering of the brain.
What Are the Types of Brain Bleeds?
Brain hemorrhages can happen inside the tissue of your brain or outside it.
When they happen outside the brain tissue, they involve one or more of the protective layers (membranes) that cover your brain:
Epidural bleed. This is when blood collects between your skull and the thick outer layer, called the dura mater. Without treatment, it can make your blood pressure rise, make it hard to breathe, cause brain damage, or lead to death.
An epidural bleed usually happens because of an injury (often involving a skull fracture) that tears an underlying blood vessel.
Subdural bleed. If blood leaks between your dura mater and the thin layer beneath it, called the arachnoid mater, you have this type of brain hemorrhage. There are three main kinds of subdural bleeds:
- Acute: This type develops quickly and is linked to a death rate that ranges from about 37% to 90%. People who survive an acute subdural bleed often have permanent brain damage. This type of brain hemorrhage can happen after a hit to the head from a fall, car crash, sports accident, whiplash, or other type of head trauma.
- Subacute: Sometimes after a head injury, the bleeding doesn't start right away. It could take days or even weeks. This slow brain bleed often happens with concussions.
- Chronic: This kind of subdural bleed happens slowly, so fast treatment can lead to a better recovery. It’s usually caused by a less-serious head injury in someone who’s 65 or older, takes blood thinners, or has changes in their brain structure due to dementia or an alcohol use disorder.
Subarachnoid bleed. This is when blood collects below the arachnoid mater and above the delicate inner layer beneath it, the pia mater. Without treatment, it can lead to permanent brain damage and death.
A bleed like this usually happens because of a head trauma, like hitting your head in a car accident. But sometimes it can be due to a brain aneurysm, a bulge in one of your brain vessels. And another issue with your blood vessels or a separate health condition can also cause it. The main warning sign for this type of bleed is a sudden, severe headache.
Intracerebral hemorrhage. With this type of brain hemorrhage, blood pools in the tissue of your brain. It’s the second most common cause of stroke, and recovering from it can be challenging. It’s usually due to long-term, untreated high blood pressure.
Intraventricular hemorrhage. In this case, bleeding happens within the ventricles of your brain -- the little chambers that typically contain cerebral spinal fluid. That may damage your nerve cells and lead to lasting brain injury. Intraventricular hemorrhage is more common in premature babies or babies who are born with very low birthweights (under 3 1/2 pounds).
Brain hemorrhage vs. intracranial hematoma
A brain hemorrhage refers to bleeding inside your brain or in between your brain and your skull. The blood that collects as a result is called an intracranialhematoma. It can require surgery right away to remove the extra blood and relieve the pressure that it's putting on your brain.
What Causes Brain Hemorrhage?
There are several causes of brain hemorrhages. The most common include:
Head trauma. Injury is the most common cause of brain bleeds in people younger than age 50.
High blood pressure. Over time, this ongoing condition can weaken the walls of your blood vessels. Untreated high blood pressure is a major preventable cause of brain hemorrhages.
Aneurysm. A weakening in one of your blood vessel walls can make it swell. It can burst and bleed into your brain, leading to a stroke.
Blood vessel abnormalities(arteriovenous malformations). You might be born with weakened blood vessels in and around your brain. But you might not know about them unless you start having symptoms.
Amyloid angiopathy. This is an abnormality of the blood vessel walls that sometimes occurs with aging and high blood pressure. It may cause many small, unnoticed bleeds before causing a large one.
Blood or bleeding disorders. Hemophilia and sickle cell anemia can both cause decreased levels of platelets, blood cells that stop bleeding by forming clots.
Liver disease. This condition is linked to increased bleeding in general.
Brain tumors. More studies need to be done to understand which types of tumors are likely to bleed.
Who Is at Risk for Brain Hemorrhages?
A brain bleed can happen to anyone, no matter how young or old you are. But some of the reasons that it's more likely to happen are:
- You have high blood pressure.
- You have a substance use disorder.
- You use tobacco.
- You take blood thinners.
- You have a health condition that weakens your blood vessels.
- You're pregnant or had a complication either during or after the birth of your baby.
- You injure your head.
- You have a brain tumor.
Brain Bleed Symptoms
The symptoms of a brain hemorrhage can vary. They depend on where the bleeding is, how much it's bleeding, and the amount and location of your brain tissue that's affected. Symptoms often start all of a sudden. Then they may get worse over time.
Common symptoms of a brain hemorrhage include:
- A sudden, severe headache
- Sensitivity to light
- Seizures with no previous history of seizures
- Weakness in an arm or leg
- Nausea or vomiting
- Decreased alertness; lethargy
- Changes in vision (like double vision)
- A drooping eyelid
- Stiff neck
- Trouble breathing
- Abnormal heart rate
- Tingling or numbness
- Difficulty speaking or understanding others
- Trouble swallowing
- Difficulty writing or reading
- Loss of fine motor skills (like being unable to tie your shoes or turn a doorknob)
- Hand tremors
- Feeling dizzy
- Loss of balance
- An abnormal sense of taste
- Loss of consciousness (passing out)
Keep in mind that a lot of these symptoms can be caused by many other conditions. But because a brain hemorrhage can be a life-threatening condition, it's important to play it safe. Call 911 or go to an emergency room as soon as you can.
Brain Hemorrhage Treatment
Once you see a doctor, they can figure out which part of your brain is affected based on your symptoms.
After a physical exam, they'll likely run some imaging tests, such as a CT scan, which can reveal internal bleeding, or an MRI. Other tests can help identify the cause of your brain hemorrhage. For instance, your doctor might order bloodwork, a urine test, X-rays, or an electroencephalogram (EEG), a painless test that checks your brain activity.
Your treatment will depend on the location, cause, and extent of your brain hemorrhage. In some cases, you might be prescribed medication to ease your symptoms and prevent the bleeding from getting worse. If so, you might be prescribed one of more of the following:
- Blood pressure medication
- Pain reliever
- Corticosteroids
- Antidepressants
- Anti-seizure drugs
- Osmotics (to reduce swelling)
In more severe cases, emergency surgery is needed to stop the bleeding, relieve pressure on your brain, and get rid of blood that's collected in areas where it shouldn't be. Your doctor may need to act quickly to prevent complications.
Complications of Brain Hemorrhages
Complications include:
- Breathing issues
- Trouble swallowing, eating, and drinking
- Loss of movement
- Weakness or numbness in body parts
- Seizures
- Memory loss
- Finding it hard to focus
- Trouble thinking clearly
- Vision loss
- Personality changes
- Complete loss of brain function
Getting treatment right away can help prevent these complications. Side effects from medications or treatments is also possible.
Brain Hemorrhage Recovery
Everyone's recovery is different. How well you heal from a brain hemorrhage depends on many factors, including your general health, the size of the hemorrhage, where it is in your brain, and how quickly it's discovered and treated.
Some people recover completely. But it's also common to need extra support (rehabilitation). Your doctor could suggest:
- Physical therapy to help you regain range of motion and strength
- Occupational therapy, which can help you learn skills to take care of yourself and manage your daily routine
- Speech therapy, which can help you better communicate with others
Can Brain Hemorrhages Be Prevented?
Most brain hemorrhages are linked to specific risk factors, so there are steps you can take right now to protect yourself. Try to:
- Treat high blood pressure. Studies show that 80% of cerebral hemorrhage patients have a history of high blood pressure. The single most important thing you can do is control yours by eating healthy foods, getting regular exercise, and taking medication as prescribed.
- Quit using tobacco. If you need help giving up this habit, ask your doctor.
- Stop using illegal drugs. Cocaine, for example, can increase the risk of bleeding in your brain.
- Watch your alcohol intake.
- Keep an eye on your cholesterol. This waxy substance can build up in your blood vessels and damage them. Men between the ages of 45 to 65 years and women between the ages of 55 to 65 years should get a cholesterol test every 1-2 years. Medication can help lower your cholesterol if a test shows that your levels are high.
- Drive carefully, and wear your seatbelt.
- If you ride a motorcycle, bike, or skateboard, always wear a helmet.
- Eat healthy foods that will help you get to a healthy weight. If you're not sure where to start, ask your doctor for tips on meal ideas and portion sizes.
- Be careful with warfarin (Coumadin). If you take this blood-thinning drug follow up regularly with your doctor to make sure your blood levels are in the correct range.
- Monitor your blood sugar levels if you have diabetes.
Takeaways
A brain hemorrhage is a medical emergency. Getting diagnosed and starting treatment right away can greatly improve your outlook. Call 911 or go to the hospital if you start having any symptoms of a brain bleed.
