Intracranial Bleeding

Overview

Intracranial bleeding, or intracranial hemorrhage, is bleeding that happens inside the skull. Because the skull is a closed space, even a small amount of bleeding can raise pressure on the brain and damage delicate tissue. This makes intracranial bleeding a medical emergency that requires immediate care.

Bleeding can occur within the brain tissue itself or in the spaces between the brain and the skull. The location and size of the bleed determine the symptoms and the urgency of treatment. Rapid recognition and emergency treatment can be life-saving and improve the chance of recovery.

If you suspect a brain bleed or stroke, call emergency services right away.

Symptoms

Symptoms often come on suddenly and can worsen quickly. They include:

• A sudden, severe headache, sometimes described as the worst of your life
• Weakness, numbness, or paralysis on one side of the face, arm, or leg
• Trouble speaking or understanding speech
• Sudden vision changes
• Loss of balance, dizziness, or trouble walking
• Confusion, drowsiness, or loss of consciousness
• Nausea and vomiting
• Seizures

These are emergency warning signs. Call emergency services immediately rather than waiting to see if symptoms improve.

Types

Intracranial bleeding is grouped by where it occurs:

• Intracerebral hemorrhage: Bleeding within the brain tissue, often linked to high blood pressure.
• Subarachnoid hemorrhage: Bleeding into the space surrounding the brain, frequently from a ruptured aneurysm.
• Subdural hemorrhage: Bleeding between the brain's outer covering and the brain, common after head injury, especially in older adults.
• Epidural hemorrhage: Bleeding between the skull and the outer covering of the brain, usually from trauma.

Causes

Several conditions can cause bleeding inside the skull:

• Head trauma from falls, crashes, assaults, or sports injuries
• High blood pressure, which weakens small blood vessels over time
• Brain aneurysm that ruptures
• Blood-thinning medication or bleeding disorders
• Abnormal blood vessels, such as arteriovenous malformations
• Brain tumors that bleed

Diagnosis

Diagnosis must be fast. After a brief assessment of consciousness and neurological function, doctors use imaging to find and measure the bleed.

• CT scan of the head: The quickest and most common test to detect bleeding.
• MRI: Provides detailed images and can help find the cause.
• CT or catheter angiography: Used to look for aneurysms or abnormal vessels.
• Blood tests to check clotting and other factors.

Treatment

Treatment depends on the type, size, location, and cause of the bleed, and aims to stop the bleeding, relieve pressure, and prevent further damage.

• Stabilization: Supporting breathing, blood pressure, and circulation.
• Controlling blood pressure and reversing blood thinners when present.
• Medications to reduce swelling and prevent seizures.
• Surgery: Procedures to remove a large clot, relieve pressure, or repair a ruptured aneurysm or abnormal vessel.
• Intensive monitoring in a hospital, often in a critical care unit.

Recovery varies widely. Many people benefit from rehabilitation, including physical, occupational, and speech therapy.

Prevention

• Keep blood pressure well controlled with lifestyle measures and any prescribed medication
• Wear seatbelts and helmets to reduce head injury
• Reduce fall risks at home, especially for older adults
• Take blood thinners exactly as directed and attend monitoring appointments
• Do not smoke, and limit heavy alcohol use

When to See a Doctor

Intracranial bleeding is a life-threatening emergency. Call emergency services immediately if you or someone else has:

• A sudden, severe headache unlike any before
• Sudden weakness, numbness, or drooping on one side of the body or face
• Trouble speaking, confusion, or loss of consciousness
• Sudden vision loss, severe dizziness, or a seizure
• Any worsening symptoms after a head injury

Do not drive yourself. Quick treatment saves lives and brain function.

Related Topics

Frequently Asked Questions

References

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