What Is a Brain Bleed?

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Bleeding in the brain, also called brain hemorrhage, is a serious medical emergency. A brain bleed can occur with head trauma, a brain tumor, or bleeding from a blood vessel in the brain.

It's also described as an intracranial (in the skull) or intracerebral (in brain tissue) hemorrhage.

A brain bleed can result in serious complications. These include weakness of the body, loss of consciousness, seizures, and even death.

Hispanic nurse comforting patient at scanner
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It is vital to get medical attention as promptly as possible for any symptoms of a brain bleed. Brain bleeds can be diagnosed quickly with imaging tests.

Treatment is typically aimed at reducing the bleeding and any cerebral edema (brain swelling). Surgical intervention may be necessary, especially if a brain tumor or a brain aneurysm (blood vessel ballooning) is the cause.

This article discusses the symptoms and causes of a brain bleed. It also covers how brain bleeding is diagnosed and treated.

Brain Bleed Symptoms

Brain bleeds can affect children or adults. A brain bleed may cause symptoms that rapidly worsen over the course of hours or days.

Symptoms of a brain bleed can include:

  • Head pain
  • Neck or back pain
  • Neck stiffness
  • Vision changes
  • Photophobia (sensitivity to light)
  • Weakness on one side of the face or body
  • Slurred speech
  • Lethargy
  • Nausea and vomiting
  • Confusion
  • Behavioral changes
  • Seizures
  • Collapsing
  • Loss of consciousness

Typically, the effects of a brain bleed are severe. However, they can be non-specific, so you may not recognize that they are associated with a brain issue.

Lethargy (lack of energy) is a serious concern when it comes to brain bleeds. This is because you may sleep for hours as the bleed continues unabated. This can lead to brain herniation (brain tissue moving from the pressure or swelling), respiratory arrest, and subsequent death.

If you or someone else has risk factors for a brain bleed or is demonstrating symptoms of a brain bleed, seek medical attention immediately. Getting emergency care can reduce the chances of long-term effects and complications.

Complications

A brain bleed may cause permanent damage to the affected regions of the brain.

This could result in:

  • Permanent paralysis of part of the body
  • Cognitive disabilities (trouble thinking)
  • Recurrent seizures
  • An inability to independently care for oneself.

Severe bleeding can cause edema (swelling) to develop. Sometimes, the combination of bleeding and edema can cause brain compression, which damages the brain.

In some instances, a midline shift of the brain will be identified. This is a dangerous situation in which the brain is actually shifted to one side, causing further compression on the brain.

Causes

All blood vessels can bleed, but bleeding of a blood vessel in the brain is not common. If it occurs, there is usually a precipitating factor. Some blood vessels in the brain are more likely to bleed than others.

Causes and types of bleeding in the brain include:

  • Head trauma: Head trauma can be caused by a fall, car accident, sports injury, or assault. When bleeding occurs, it's usually between the skull and surrounding membrane (meninges), described as a subdural hematoma. Head trauma can also increase the risk of a stroke.
  • Hemorrhagic conversion: An ischemic stroke is brain damage caused by interrupted blood flow in the brain. In some cases, brain damage from an ischemic stroke can cause the brain tissue to become fragile and bleed. This stroke complication is called a hemorrhagic conversion.
  • Ruptured aneurysm: A brain aneurysm is an outpouching of an artery. It can burst with high blood pressure that comes on suddenly (malignant hypertension) or the weakening of a blood vessel. This can lead to a subarachnoid hemorrhage, a type of bleed that occurs beneath the meninges. A subarachnoid hemorrhage typically causes a severe headache and loss of consciousness, leading to death in 20% to 50% of cases.
  • Brain tumor: A brain tumor can cause the area near the tumor to bleed. This occurs as the tumor (and intracranial pressure associated with it) causes tiny nearby vessels to thin, break, and bleed.
  • Spontaneous bleeding: It's rare for spontaneous bleeding to occur in the brain. When it does, it often affects the cerebral cortex (the outer layer of the brain) or internal capsule (a communication pathway). This can cause the same symptoms as a stroke.

    A condition referred to as amyloid angiopathy makes blood vessels fragile and more likely to bleed. This is a type of hemorrhagic stroke. It may be precipitated by the use of blood thinners or a bleeding disorder.

Risk Factors

There are several risk factors for brain bleeds, including:

These risk factors can make you more likely to experience a brain bleed after head trauma.

People over 75 are more susceptible to brain bleeds due to aging-related changes. These include increased fragility of blood vessels and impaired blood clotting.

Diagnosis

Brain bleeds are typically diagnosed with a computerized tomography (CT) scan of the brain. This imaging test is generally more sensitive to acute bleeds in emergency situations than magnetic resonance imaging (MRI). With that said, MRIs are better able to detect smaller intracranial hemorrhages than CT.

Imaging tests can identify the location and size of a bleed, and sometimes they can visualize a blood clot inside a blood vessel.

Based on imaging tests, a radiologist, neurologist, or neurosurgeon can determine when a subdural hematoma first started.

The timing is classified into three categories:

  • Acute subdural hematoma: One to two days prior
  • Subacute subdural hematoma: Three to 14 days prior
  • Chronic subdural hematoma: More than two weeks prior

Follow-Up Imaging

Often, with brain bleeds, follow-up CT scans are needed to determine if:

  • Bleeding is continuing or has stopped.
  • Edema is worsening, stabilizing, or improving.
  • A blood clot is continuing to grow, stabilize, or shrink.

Further Tests

You may need other tests to assess the cause and effect of a brain bleed, depending on the circumstances.

  • Brain angiogram: Different types of angiograms include CT angiogram, MR angiogram, and catheter-assisted angiogram (which is an invasive test). An angiogram may identify a brain aneurysm that has ruptured or an aneurysm that has not ruptured. This can help in treatment planning.
  • Lumbar puncture (LP): Also called a spinal tap, this can detect blood cells or cancer cells in the cerebrospinal fluid (CSF) surrounding the brain and spinal cord. An LP can be dangerous if you have a large bleed, severe edema, or a risk of a midline shift. That's because the removal of spinal fluid can cause a change in pressure in the brain and may precipitate a midline shift. However, in certain circumstances, an LP can be helpful in assessing a brain bleed.
  • Electroencephalogram (EEG): An EEG is a brain wave test that can detect the likelihood of seizures. It can also help in assessing brain activity when a brain bleed has caused decreased consciousness or coma. This is a valuable way to monitor the effects of medications and edema.

Treatment

There are several treatment strategies for managing a brain bleed and preventing complications. Your treatment depends on the size, location, cause, and effects of your brain bleed.

Emergency surgery may be necessary. Medical intervention is also typically needed and may continue for weeks after a procedure.

In some cases, however, no treatment is used at all (e.g., with a small subdural hematoma). But close medical monitoring can help determine whether your condition worsens, in which case treatment may be needed.

Often, rehabilitation is necessary after recovery from a brain bleed.

Surgical Intervention

Prior to surgery, intravenous (IV) steroids are often used to reduce swelling in the brain caused by bleeding or by a tumor. Each type of brain bleed and its complications require a specific surgical procedure.

Brain bleed types and their surgical treatments include:

  • Subdural hematoma: A large subdural hematoma may need to be removed surgically. Recovery can be very good, especially if there was no severe or prolonged neurological impairment prior to surgery.
  • Brain tumor: A tumor and the surrounding bleeding may need to be removed. However, when there are many tumors in the brain, surgery may not be an option and radiation may be considered instead.
  • Brain aneurysm: An aneurysm may need to be repaired. This is a complicated neurosurgical procedure that may be done with a minimally invasive technique in some situations.
  • Edema: A decompressive hemicraniectomy involves the temporary removal of a portion of the skull to relieve the pressure caused by excessive edema. Once the swelling subsides, the section of the skull that was removed is put back into place, and the bone will seal over time.

Medical Intervention

In addition to surgical interventions, medical management is often necessary. You may need IV fluids with closely controlled sodium and glucose (sugar) concentrations to prevent additional edema.

Steroids are often needed to reduce inflammation and edema. Anti-epilepsy drugs (AEDs) may also be necessary to control seizures.

Rehabilitation

After the immediate treatment of a brain bleed, you may need physical therapy or speech therapy. Often, people recovering from a brain bleed need assistance with self-care. You may need to relearn things such as how to eat, speak, or walk.

Recovery can take a long time. It may take up to a year to regain your abilities and many people only experience partial recovery. Rehabilitation after a brain bleed is similar to the rehabilitation process after an ischemic stroke.

After recovering from a brain bleed, you should not expect the bleeding to recur.

Summary

Bleeding in the brain is a serious medical emergency that can lead to disability or death. If you suspect a brain bleed, call for emergency help. Symptoms can be non-specific and may include head pain, neck pain, visual changes, weakness, slurred speech, lethargy, confusion, seizures, vomiting, and collapsing.

Brain bleeding can be caused by head trauma from a fall or accident. It can also be caused by a stroke, brain aneurysm, brain tumor, or rarely, spontaneous bleeding. Healthcare providers usually diagnose brain bleeding with imaging tests, including a CT scan or an MRI.

Treatment depends on the size and location of the brain bleed. Urgent surgery may be needed to remove a large subdural hematoma, brain tumor, or part of the skull to relieve pressure on the brain. Rehabilitation may be needed to help you relearn how to do things like eat, walk, or talk.

A Word From Verywell

There are several types of brain bleeds, and while they are dangerous, recovery is possible. If you experience or encounter someone who is experiencing signs of a brain bleed, seek help immediately. Getting emergency treatment is the best way to optimize the outcome. Over time, you can have substantial improvement after a bleed in the brain, especially with prompt treatment and consistent rehabilitation.

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By Eva Hvingelby, NP, PhD
Eva Hvingelby NP, PhD, is a nurse practitioner, researcher, educator, and health consultant specializing in trauma.