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Brain Hemorrhage: Causes, Symptoms, Treatments

Medically Reviewed by Christopher Melinosky, MD on September 14, 2020

A brain hemorrhage is a type of stroke. It's caused by an artery in the brain bursting and causing localized bleeding in the surrounding tissues. This bleeding kills brain cells.

Brain hemorrhages are also called cerebral hemorrhages, intracranial hemorrhages, or intracerebral hemorrhages. They account for about 13% of strokes.

Since some brain hemorrhages can be disabling or life-threatening, it’s important to get medical help fast if you think someone is having one. Here’s what you need to know about the causes, symptoms, treatments, and more.

What Happens During a Brain Hemorrhage?

When blood from trauma irritates brain tissues, it causes swelling. This is known as cerebral edema. The pooled blood collects into a mass called a hematoma. These conditions increase pressure on nearby brain tissue, and that reduces vital blood flow and kills brain cells.

Bleeding can occur inside the brain, between the brain and the membranes that cover it, between the layers of the brain's covering or between the skull and the covering of the brain.

What Causes Bleeding in the Brain?

There are several risk factors and causes of brain hemorrhages. The most common include:

  • Head trauma. Injury is the most common cause of bleeding in the brain for those younger than age 50.
  • High blood pressure. This chronic condition can, over a long period of time, weaken blood vessel walls. Untreated high blood pressure is a major preventable cause of brain hemorrhages.
  • Aneurysm. This is a weakening in a blood vessel wall that swells. It can burst and bleed into the brain, leading to a stroke.
  • Blood vessel abnormalities. (Arteriovenous malformations) Weaknesses in the blood vessels in and around the brain may be present at birth and diagnosed only if symptoms develop. 
  • Amyloid angiopathy. This is an abnormality of the blood vessel walls that sometimes occurs with aging and high blood pressure. It may cause many small, unnoticed bleeds before causing a large one.
  • Blood or bleeding disorders. Hemophilia and sickle cell anemia can both contribute to decreased levels of blood platelets and clotting. Blood thinners are also a risk factor. 
  • Liver disease. This condition is associated with increased bleeding in general.
  • Brain tumors.

What Are the Symptoms of Brain Bleeding?

The symptoms of a brain hemorrhage can vary. They depend on the location of the bleeding, the severity of the bleeding, and the amount of tissue affected. Symptoms tend to develop suddenly. They may progressively worsen. 

If you exhibit any of the following symptoms, you may have a brain hemorrhage. This is a life-threatening condition, and you should call 911 or go to an emergency room immediately. The symptoms include:

  • A sudden severe headache
  • Seizures with no previous history of seizures
  • Weakness in an arm or leg
  • Nausea or vomiting
  • Decreased alertness; lethargy
  • Changes in vision
  • Tingling or numbness
  • Difficulty speaking or understanding speech
  • Difficulty swallowing
  • Difficulty writing or reading
  • Loss of fine motor skills, such as hand tremors
  • Loss of coordination
  • Loss of balance
  • An abnormal sense of taste
  • Loss of consciousness

Keep in mind that many of these symptoms are often caused by conditions other than brain hemorrhages.

What Are the Types of Brain Bleeds?

Bleeds can happen inside the tissue of your brain or outside it.

When they happen outside the brain tissue, they involve one or more of the protective layers (membranes) that cover your brain:

Epidural bleed. This is when blood collects between your skull and the thick outer layer, called the dura mater. Without treatment, it can make your blood pressure rise, give you trouble breathing, cause brain damage, or lead to death.

An epidural bleed usually happens due to an injury (often involving a skull fracture) that tears an underlying blood vessel.

Subdural bleed. This is when blood leaks between your dura mater and the thin layer beneath it, called the arachnoid mater. There are two main kinds of subdural bleeds: The “acute” type develops fast, and it’s linked to a death rate that ranges from about 37% to 90%. It’s common for people who survive one to have permanent brain damage.

Acute subdural bleeds can happen after a hit to the head from a fall, car crash, sports accident, whiplash, or other type of trauma.

Chronic subdural bleeds form gradually and aren’t as deadly -- fast treatment can lead to a better recovery, too. It’s usually caused by a less-serious head injury in someone who’s elderly, on blood thinning meds, or has brain shrinkage due to dementia or an alcohol use disorder.

Subarachnoid bleed. This is when blood collects below the arachnoid mater and above the delicate inner layer beneath it, the pia mater.  Without treatment, it can lead to permanent brain damage and death.

This type of bleed usually happens due to a brain aneurysm. Sometimes a problem with blood vessels or other health problems can cause it. The main warning sign for this type of bleed is a sudden, severe headache.

Intracerebral hemorrhage. This is when blood pools in the tissue of your brain. It’s the second most common cause of stroke as well as the deadliest. It’s usually due to long-term, untreated high blood pressure.

How Is a Brain Hemorrhage Treated?

Once you see a doctor, they can determine which part of the brain is affected based on your symptoms.

Doctors may run a variety of imaging tests, such as a CT scan, which can reveal internal bleeding or blood accumulation, or an MRI. A neurological exam or eye exam, which can show swelling of the optic nerve, may also be performed. A lumbar puncture (spinal tap) is usually not performed, as it may be dangerous and make things worse.

Treatment for bleeding in the brain depends on the location, cause, and extent of the hemorrhage. Surgery may be needed to alleviate swelling and prevent bleeding. Certain medications may also be prescribed. These include painkillers, corticosteroids, or osmotics to reduce swelling, and anticonvulsants to control seizures.

Can People Recover From Brain Hemorrhages, and Are There Possible Complications?

How well a patient responds to a brain hemorrhage depends on the size of the hemorrhage and the amount of swelling.

Some patients recover completely. Possible complications include stroke, loss of brain function, seizures, or side effects from medications or treatments. Death is possible, and may quickly occur despite prompt medical treatment.

Can Brain Hemorrhages Be Prevented?

Because the majority of brain hemorrhages are associated with specific risk factors, you can minimize your risk in the following ways:

  • Treat high blood pressure. Studies show that 80% of cerebral hemorrhage patients have a history of high blood pressure. The single most important thing you can do is control yours through diet, exercise, and medication.
  • Don’t smoke.
  • Don’t use drugs. Cocaine, for example, can increase the risk of bleeding in the brain.
  • Drive carefully, and wear your seat belt.
  • If you ride a motorcycle, bicycle or skateboard, always wear a helmet.
  • Investigate corrective surgery. If you suffer from abnormalities, such as aneurysms, surgery may help to prevent future bleeding.
  • Be careful with warfarin (Coumadin). If you take this blood-thinning drug follow up regularly with your doctor to make sure your blood levels are in the correct range.

Show Sources

SOURCES:

Journal of Stroke: “Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update.”

Cleveland Clinic: “Brain Bleed, Hemorrhage (Intracranial Hemorrhage),” “Subdural Hematoma.”

Harvard Health: “Head Injury In Adults.”

StatPearls: “Intracranial Hemorrhage.”

UCLA Health: “Acute Subdural Hematomas,” “Chronic Subdural Hematomas,” “Acute Subdural Hematomas,” “Intracerebral Hemorrhage.”

American Association of Neurological Surgeons: “Intracerebral Hemorrhage.”

Mayo Clinic: “Meninges,” “Subarachnoid hemorrhage.”

Medscape: “What is the prognosis of subdural hematoma (SDH)?,” “Subdural Hematoma.”

Medline Plus Encyclopedia: "Intracerebral Hemorrhage."

Cedars Sinai: "Brain Hemorrhage."

American Stroke Association: "Let’s Talk About Hemorrhagic Strokes."

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