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 as a result of head trauma, a brain tumor, or bleeding from a blood vessel in the brain.

Also described as intracranial or intracerebral hemorrhages—depending on where they occur—a brain bleed can result in serious complications, including weakness of the body, loss of consciousness, seizures, and even death.

Hispanic nurse comforting patient at scanner
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While brain bleeds can be diagnosed quickly with imaging tests, the key is to get medical attention as promptly as possible.

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

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
  • 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, but they can be non-specific, so you may not recognize that they are associated with a brain issue.

Lethargy (the 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, 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, you need to seek medical attention urgently. Long-term effects and complications of an intracranial bleed may be reduced with urgent treatment.

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, and 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 may further damage 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, which also causes 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: Any type of head trauma, such as can be caused by a fall, car accident, sports injury, or assault, can cause bleeding in the brain. The most common area of bleeding after head trauma is the area between the skull and surrounding membrane (meninges), described as a subdural hematoma. Additionally, head trauma can also increase the risk of a stroke.
  • Hemorrhagic conversion: A stroke is brain damage caused by interrupted blood flow in the brain. An ischemic stroke, characterized by inadequate blood flow to the brain, can sometimes trigger a hemorrhagic stroke if it is severe and prolonged enough. The process, called hemorrhagic conversion, usually develops after the blockage of a blood vessel causes it to burst.
  • Ruptured aneurysm: A brain aneurysm is an outpouching of an artery. It can burst as a result of malignant hypertension or simply due to the weakening of the 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 is rare for spontaneous bleeding to occur in the brain. When it does, the bleed often affects the cerebral cortex or internal capsule, causing the same symptoms as a stroke. A condition referred to as amyloid angiopathy 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 particularly 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, such as increased fragility of blood vessels and impaired blood clotting.

Diagnosis

Brain bleeds are typically diagnosed with computerized tomography (CT) scan of the brain. These imaging tests are 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.

Besides identifying the location of blood in the brain, imaging tests are also able to determine the size of a bleed and whether a blood clot has formed.

Based on imaging tests, lab technicians can determine when a subdural hematoma first started, the timing of which is classified into three categories:

  • Acute subdural hematoma: 1 to 2 days prior
  • Subacute subdural hematoma: 3 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
  • The blood clot is continuing to grow, stabilizing, or shrinking

Further Tests

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

  • Brain angiogram: In some instances, when symptoms are very consistent with a subarachnoid hemorrhage, an imaging test may not show bleeding. An angiogram may identify a brain aneurysm even when blood is not identified on a brain CT or MRI. This can help in planning treatment.
  • Lumbar puncture (LP): Also called 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 because it can trigger bleeding and even 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 seizures and predisposition to them. It can also help in assessing brain activity when a brain bleed has caused decreased consciousness or coma. This is a valuable way to determine 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.

Surgery is often done, usually emergently. 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 can be surgically treated, and the treatment for each type differs.

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 not 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.

Medical Intervention

In addition to surgical interventions, medical management is often necessary. You may need IV fluids with closely controlled sodium 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 and may need to re-learn 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 used after a stroke.

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

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.

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