Brain Hemorrhage

Overview

A brain hemorrhage is bleeding that occurs inside the skull when a blood vessel in or around the brain bursts. It is one type of stroke, sometimes called a hemorrhagic stroke. The leaking blood can damage brain tissue directly and, as it pools, raise pressure inside the skull, which deprives the brain of oxygen and can cause further harm.

A brain hemorrhage is a life-threatening emergency. The faster a person receives medical care, the better the chance of limiting damage and saving life. Bleeding can happen in different locations, including within the brain tissue itself or in the spaces surrounding the brain, and the symptoms and outlook depend on where and how much bleeding occurs. Recognizing the warning signs and calling emergency services immediately is critical.

If you suspect a brain hemorrhage or stroke, call emergency services right away. Do not wait to see if symptoms improve.

Symptoms

Symptoms usually come on suddenly and can worsen quickly. They depend on the location and amount of bleeding.

• A sudden, severe headache, sometimes described as the worst headache of one's life
• Sudden weakness, numbness, or paralysis, often on one side of the face, arm, or leg
• Difficulty speaking, slurred speech, or trouble understanding others
• Sudden confusion, drowsiness, or loss of consciousness
• Vision changes in one or both eyes
• Loss of balance, dizziness, or difficulty walking
• Nausea and vomiting, seizures, and a stiff neck

These are emergency symptoms. Call emergency services immediately if you or someone else has any of them. Use the FAST check: Face drooping, Arm weakness, Speech difficulty, Time to call emergency services.

Causes

A brain hemorrhage happens when a blood vessel in or near the brain ruptures. Common causes include:

• High blood pressure: The most common cause, as long-term high pressure weakens vessel walls until they burst.
• Head injury: Trauma from falls, accidents, or assaults, especially in younger people.
• Aneurysm: A weak, bulging area in a blood vessel wall that can rupture.
• Abnormal blood vessels: Tangles of vessels (arteriovenous malformations) present from birth.
• Blood-thinning medicines and bleeding disorders: These increase bleeding risk.
• Other causes: Weakened vessels from aging, certain brain tumors, and heavy alcohol or drug use.

Risk Factors

• High blood pressure, particularly if untreated
• Older age
• Smoking and heavy alcohol use
• Use of blood-thinning medicines or a bleeding disorder
• A known aneurysm or arteriovenous malformation
• Use of stimulant drugs such as cocaine
• A previous stroke or head injury

Diagnosis

Because a brain hemorrhage is an emergency, diagnosis is done urgently in hospital. Tests include:

• CT scan: A rapid brain scan that is usually the first test, able to detect bleeding quickly
• MRI scan: Provides detailed images and may be used to find the cause and assess damage
• Angiography: Imaging of the blood vessels to locate an aneurysm or abnormal vessels
• Blood tests: To check clotting, blood counts, and other factors

Treatment

Treatment is an emergency and aims to stop the bleeding, relieve pressure on the brain, and prevent further damage. Care takes place in hospital, often in an intensive care or stroke unit.

• Stabilizing and supporting: Controlling blood pressure, supporting breathing, and reversing the effects of blood-thinning medicines when needed.
• Reducing pressure: Medicines and, in some cases, surgery to remove pooled blood or drain excess fluid.
• Surgery: To repair a ruptured aneurysm or abnormal vessels, or to relieve pressure on the brain.
• Treating complications: Managing seizures and other problems that may arise.
• Rehabilitation: Physical, occupational, and speech therapy during recovery to regain lost abilities.

Recovery varies and can be lengthy. Some people regain much of their function, while others have lasting effects depending on the severity and location of the bleeding.

Prevention

• Keep blood pressure well controlled, the single most important step
• Do not smoke and limit alcohol
• Use blood-thinning medicines exactly as prescribed and attend monitoring
• Wear seatbelts and helmets to prevent head injuries
• Avoid stimulant drugs such as cocaine
• Manage and follow up on any known aneurysm or vessel abnormality

When to See a Doctor

A brain hemorrhage is a medical emergency. Call emergency services immediately if you or someone else has a sudden severe headache, weakness or numbness on one side of the body, trouble speaking or understanding speech, sudden confusion, vision loss, loss of balance, seizures, or loss of consciousness. Every minute counts, so do not wait to see whether symptoms improve. Faster treatment improves the chance of recovery.

Related Topics

Frequently Asked Questions

References

1. American Stroke Association. Hemorrhagic Stroke (Bleeds).
2. Mayo Clinic. Intracranial hematoma — Symptoms and causes.
3. National Institute of Neurological Disorders and Stroke (NINDS). Stroke.
4. MedlinePlus, U.S. National Library of Medicine. Bleeding in the brain.