Brain Bleed, Hemorrhage (Intracranial Hemorrhage)

What is a brain bleed?

A brain bleed (intracranial hemorrhage) is a type of stroke that causes bleeding in your head.

As your brain can’t store oxygen, it relies on a series of blood vessels to supply its oxygen and nutrients. When a brain bleed occurs, a blood vessel leaks blood or bursts. Blood collects or pools within your skull and brain. This causes pressure against your brain, which prevents oxygen and nutrients from reaching your brain tissues and cells.

Brain bleeds are common after falls or traumatic injuries. They’re also common in people with unmanaged high blood pressure.

A brain bleed is a life-threatening medical emergency. It only takes three to four minutes for your brain cells to die if they don’t receive enough oxygen. Treating a brain bleed quickly leads to the best outcome.

What are the types of brain bleeds?

There are many parts to your brain, so the term “brain bleed” (intracranial hemorrhage) is very broad to healthcare providers. Types of brain bleeds help your healthcare provider identify specifically where the bleeding occurs.

There are two main areas of bleeding:

• Within your skull but outside of brain tissue.
• Inside brain tissue.

To better understand where each type of brain bleed occurs, it helps to know the components within your skull. The brain has three membrane layers (meninges) between the bony skull and brain tissue. The three membranes are the dura mater, arachnoid and pia mater. The purpose of the meninges is to cover and protect your brain. Bleeding can occur anywhere between these three membranes.

Types of brain bleeds within your skull but outside of brain tissue include:

• Epidural bleed: This bleed happens between the skull bone and the outermost membrane layer, the dura mater.
• Subdural bleed: This bleed happens between the dura mater and the arachnoid membrane.
• Subarachnoid bleed: This bleed happens between the arachnoid membrane and the pia mater.

There are two types of brain bleeds that occur inside the brain tissue itself:

• Intracerebral hemorrhage: This bleeding occurs in the lobes, brainstem and cerebellum of your brain. This is bleeding anywhere within the brain tissue itself.
• Intraventricular hemorrhage: This bleeding occurs in your brain’s ventricles, which are specific areas of the brain (cavities) where your body makes cerebrospinal fluid (fluid that protects your brain and spinal cord).

Are brain bleeds fatal?

Brain bleeds can be life-threatening and cause permanent brain damage. The severity and outcome of a brain bleed depend on its cause, location inside of your skull, size of the bleed, the amount of time that passes between the bleed and treatment. Once brain cells die, they don’t come back. Damage can be severe and result in physical, mental and task-based disability.

How common is a brain bleed?

Brain bleeds are a type of stroke. More than 795,000 people in the United States experience a stroke each year.

What are the symptoms of a brain bleed?

Symptoms of a brain bleed vary based on the type, but could include:

• Sudden tingling, weakness, numbness or paralysis of your face, arm or leg, particularly on one side of your body.
• Sudden, severe headache.
• Nausea and vomiting.
• Confusion.
• Dizziness.
• Slurred speech.
• Lack of energy, sleepiness.

In addition, you may experience:

• Difficulty swallowing.
• Vision loss.
• Stiff neck.
• Sensitivity to light.
• Loss of balance or coordination.
• Trouble breathing and abnormal heart rate.
• Seizures.
• Loss of consciousness and coma.

What is the first symptom of a brain bleed?

Most people who experience a brain bleed note that the first symptom is a sudden, painful headache.

What causes a brain bleed?

A leaky, broken or burst blood vessel causes a brain bleed. As a result, excess blood pools in your brain. A brain bleed can happen after:

• Head trauma (a fall, car accident, sports injury, etc.).
• A buildup of fatty deposits in your arteries (atherosclerosis).
• A blood clot.
• A weak spot in a blood vessel wall (cerebral aneurysm).
• A leak from abnormally formed connections between arteries and veins (arteriovenous malformation, or AVM).
• A buildup of protein within the artery walls of the brain (cerebral amyloid angiopathy).
• A brain tumor.

What are the risk factors for a brain bleed?

A brain bleed can affect anyone at any age, from newborns to adults. It’s more common among adults over age 65. You may be more at risk of a brain bleed if you experience the following:

• High blood pressure (hypertension).
• Substance use disorder.
• Tobacco use.
• Bleeding conditions or conditions that need treatment with blood thinners (anticoagulants).
• Pregnancy and childbirth-related conditions (eclampsia, postpartum vasculopathy or neonatal intraventricular hemorrhage).
• Conditions that affect how your blood vessel walls form.

What are the complications of a brain bleed?

If not treated quickly, a brain bleed can lead to permanent brain damage or death. A lack of oxygen to your brain can destroy your brain cells and prevent them from communicating with other parts of your body. This affects how your body functions overall, so you may experience:

• Memory loss.
• Difficulty with swallowing, speech and communication.
• Coordination and movement challenges.
• Inability to move part of your body (paralysis).
• Numbness or weakness in part of your body.
• Vision loss.
• Personality changes and/or emotional changes.

How is a brain bleed diagnosed?

A healthcare provider will diagnose a brain bleed after an immediate physical exam, neurological exam and testing. They’ll review your complete medical history and your symptoms first. Then, they’ll order an imaging test like:

• A computed tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Magnetic resonance angiogram (MRA).

These imaging tests determine the location, extent and, sometimes, the cause of the bleed.

Other tests can help detect a cause and may include:

• Electroencephalogram.
• Chest X-ray.
• Urinalysis.
• Complete blood count (CBC).
• Lumbar puncture (spinal tap).
• Angiography (for an aneurysm or arteriovenous malformation).

How is a brain bleed treated?

Treatment for a brain bleed varies based on the severity and location of the bleed. Your healthcare provider will focus on stopping the bleeding and managing the cause. Treatment may include:

• Surgery.
• Medications.

Prompt medical treatment can limit damage to your brain, which will improve your chance of recovery. In addition, you may receive:

• Supplemental oxygen via a ventilator.
• Nutrients and fluids through a vein (intravenously) or a feeding tube (gastronomy tube).
• Close monitoring in an intensive care unit to make sure your vital signs are stable.

Brain bleed surgery

Surgery can treat a brain bleed to stop bleeding and address the underlying cause. Surgery may include:

• Decompression: A surgeon will drill a hole in your skull to drain blood and relieve pressure.
• Craniectomy: A surgeon will remove a piece of your skull to relieve pressure. Once your skull is open, your surgeon can treat the source of the brain bleed.
• Craniotomy: A surgeon will remove and replace a piece of your skull to relieve pressure and manage the source of bleeding.

Some brain hemorrhages don’t require surgery. The decision depends on the bleed’s size, cause and location, along with other factors like your general health.

What medications treat a brain bleed?

Based on your diagnostic test results, a healthcare provider may prescribe the following medications to treat the symptoms, the underlying cause or prevent complications of a brain bleed:

• Anti-anxiety medications.
• Antiseizure medications.
• Blood pressure management medications.
• Pain relievers.
• Steroid medications (corticosteroids).
• Stool softeners (to prevent straining and pressure).

Are there side effects of the treatment?

Each type of treatment comes with possible side effects. Due to the urgent nature of treatment for a brain bleed, you may need emergency treatment to prevent life-threatening complications.

Surgery comes at a higher risk due to the proximity of the procedure to your brain. Your highly trained surgical team will use caution to prevent possible complications.

Do I need rehabilitation after a brain bleed?

You may need rehabilitation after a brain bleed. Depending on the severity of the bleed, brain damage is a possibility that can affect your ability to complete your daily routine. Rehabilitation can help you regain the functions needed for daily living and prevent future brain bleeds.

Long-term rehabilitation treatment may include:

• Physical therapy.
• Speech therapy.
• Occupational therapy.
• Changing lifestyle habits to reduce the risk of another hemorrhage.

Rehabilitation and recovery time vary according to each person’s situation.

Can a brain bleed be prevented?

You can’t prevent all causes of brain bleeds, but you can take steps to reduce your risk by:

• Managing your blood pressure.
• Lowering your cholesterol level.
• Maintaining a healthy weight.
• Limiting alcohol consumption and stopping smoking.
• Eating healthy foods.
• Getting regular exercise.
• Regulating blood sugar levels if you have diabetes.

You can also protect yourself from injury by wearing protective equipment, like a helmet, during certain activities or wearing a seatbelt in vehicles.

What can I expect if I have a brain bleed?

Depending on the brain bleed’s location and the extent of damage, there can be lasting effects. Rehabilitation can help you manage these effects so you can complete your daily routine safely.

Unfortunately, a brain bleed can cause permanent damage, including paralysis, coma and death. Each situation is different, so a healthcare provider will be able to give you the most up-to-date information about your situation.

Remember, if you suspect a brain bleed, the sooner you get to the emergency room, the better your chance of survival. Don’t hesitate if you suspect something’s wrong. Let a healthcare professional determine if you have a brain emergency.

What are the chances of surviving a brain bleed?

Your chance of survival after a brain bleed depends on the severity of the bleed, the amount of time between the start of the bleed and treatment, your overall health and other factors. If treated at the first sign of a brain bleed, your odds of survival are good.

Studies show that stroke is the third leading cause of death in the United States. While a stroke is a common cause of death, not everyone who experiences a stroke has life-threatening complications.

A healthcare provider can give you the most accurate information about your or your loved one’s chances of survival.

When should I go to the ER?

Any type of bleeding inside of your skull or brain is a medical emergency. If you or a loved one experienced a head injury (blow to the head) or have symptoms that may indicate a brain bleed, like a sudden headache, confusion or numbness, call 911 or your local emergency services number. It’s important to get to a hospital emergency room immediately to determine the cause of your symptoms and to begin medical treatment.

What questions should I ask my healthcare provider?

• Will I have long-term complications after a brain bleed?
• What are my chances of survival?
• How often should I participate in rehabilitation?
• What side effects should I look out for?
• How do I prevent a future brain bleed?

What’s the difference between intracranial hemorrhage and intracerebral hemorrhage?

A hemorrhage means bleeding caused by a damaged blood vessel. An intracranial hemorrhage is bleeding within your skull. An intracerebral hemorrhage is bleeding within brain tissue.