Bleeding in the brain, also called brain hemorrhage, requires serious medical attention. A brain hemorrhage can result from a head injury, a brain tumor, or bleeding from a blood vessel in the brain.
A brain hemorrhage, also described as an intracranial or intracerebral hemorrhage, depending on where it occurs, can lead to serious complications, such as weakness of the body, loss of consciousness, seizures , and even death .
Although brain bleeding can be diagnosed quickly with imaging tests, the key is to get medical attention as soon as possible.
Symptoms of brain hemorrhage.
Brain bleeds can occur in children and adults. A brain hemorrhage can cause symptoms that quickly get worse over several hours or days.
Symptoms of brain hemorrhage can include:
- Neck or back pain
- Neck stiffness
- Vision changes
- Weakness on one side of the face or body.
- Speak slurred
- Nausea and vomiting
- Behavior changes
- Falling apart
- Loss of consciousness
Usually, brain hemorrhage has serious consequences, but they can be nonspecific, so you may not realize that they are related to brain problems.
Lethargy (lack of energy) is a serious problem when it comes to brain bleeds. This is because you can sleep for hours and the bleeding does not stop. This can lead to brain herniation, respiratory arrest, and subsequent death .
If you or anyone else has risk factors for brain hemorrhage or have symptoms of brain hemorrhage, you should seek immediate medical attention. The long-term consequences and complications of intracranial hemorrhage can be reduced with urgent treatment.
Bleeding in the brain can cause permanent damage to the affected areas of the brain. This can lead to permanent paralysis of a part of the body, cognitive impairment (trouble thinking), recurrent seizures, and an inability to care for yourself .
Heavy bleeding can cause edema (swelling). Sometimes a combination of bleeding and swelling can compress the brain, which can lead to further damage. In some cases, it is possible to determine the displacement of the midline of the brain. This is a dangerous situation where the brain drifts to one side, which also causes the brain to contract .
All blood vessels can bleed, but bleeding from blood vessels in the brain is rare. If this happens, there is usually a provoking factor. Some blood vessels in the brain are more likely to bleed than others.
The causes and types of bleeding in the brain include:
- Head injury: Any type of head injury , such as that caused by a fall, a car accident, a sports injury, or an assault, can cause bleeding in the brain. The most common area of bleeding after a head injury is the area between the skull and the surrounding meninges (meninges), described as a subdural hematoma . Additionally, a head injury can also increase the risk of stroke .
- Hemorrhagic conversion: A stroke is damage to the brain caused by poor blood flow to the brain. Ischemic stroke , characterized by insufficient blood flow to the brain, can sometimes cause a hemorrhagic stroke if it is severe and long enough. A process called hemorrhagic conversion usually develops after a blockage in a blood vessel causes it to rupture .
- Ruptured aneurysm: A brain aneurysm is a prolapse of an artery. It can burst as a result of malignant hypertension or simply due to a weakened blood vessel. This can lead to a subarachnoid hemorrhage , a type of bleeding that occurs under the meninges. Subarachnoid hemorrhage usually causes severe headache and loss of consciousness, leading to death in 20-50% of cases .
- Brain tumor : A brain tumor can cause bleeding in an area near the tumor. This is because the tumor (and associated intracranial pressure) causes nearby small vessels to thin, rupture, and bleed .
- Spontaneous bleeding : Spontaneous bleeding in the brain is rare. When this happens, bleeding often affects the cerebral cortex or the inner capsule , causing the same symptoms as a stroke . A condition called amyloid angiopathy can be triggered by taking blood thinners or a blood clotting disorder .
There are several risk factors for brain hemorrhage, including:
These risk factors can increase the chance of brain hemorrhage after a head injury.
People over the age of 75 are more prone to brain bleeds due to age-related changes, such as increased fragility of blood vessels and blood clotting disorders .
Brain bleeds are usually diagnosed with a computed tomography (CT) scan of the brain. These imaging techniques are often more sensitive to acute bleeding in an emergency than magnetic resonance imaging (MRI) . That said, MRI is better at detecting smaller intracranial hemorrhages than CT scan .
In addition to locating the location of the blood in the brain, imaging tests can also determine the size of the bleeding and the formation of blood clots .
Based on imaging tests, technicians can determine when a subdural hematoma first occurred, the time of which is divided into three categories:
- Acute subdural hematoma: 1-2 days before
- Subacute subdural hematoma: 3 to 14 days before
- Chronic subdural hematoma: more than two weeks ago
Often with brain bleeds, a repeat CT scan is required to determine:
- The bleeding continues or has stopped.
- Swelling worsens, stabilizes, or improves
- The blood clot continues to grow, stabilize, or shrink .
Depending on the circumstances, you may need other tests to evaluate the cause and effect of the brain hemorrhage.
- Cerebral angiogram: In some cases where symptoms are very similar to subarachnoid hemorrhage, an imaging test may not show bleeding. An angiogram can reveal a brain aneurysm even if no blood is found on a CT scan or MRI of the brain. This can help with treatment planning .
- Lumbar puncture (LP) : Also called a lumbar puncture, it can detect blood cells or cancer cells in the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. LP can be dangerous if you have heavy bleeding, severe swelling, or the risk of a midline shift, because it can cause bleeding and even lead to a midline shift. However, in certain circumstances, LP can be useful in evaluating cerebral hemorrhage.
- Electroencephalogram (EEG) : An EEG is a brain wave test that can detect seizures and a predisposition to them. It can also help assess brain activity when brain hemorrhage has caused decreased consciousness or coma. This is a valuable way to determine the effects of drugs and edema .
There are several treatment strategies to stop bleeding in the brain and prevent complications. Your treatment depends on the size, location, cause, and effect of the bleeding in your brain.
The operation is done frequently, usually urgently. Usually a medical intervention is also required, which can continue for several weeks after the procedure.
However, in some cases, treatment is not used at all (for example, with a small subdural hematoma). But close medical supervision can help determine if your condition is worsening, in which case treatment may be required.
Rehabilitation is usually necessary after recovering from a brain hemorrhage.
Before surgery, intravenous (IV) steroids are often used to reduce brain edema caused by bleeding or swelling. Each type of brain hemorrhage can be treated with surgery, and the treatment for each type is different.
Types of brain hemorrhage and their surgical treatments include:
- Subdural hematoma: Surgical removal of a large subdural hematoma may be necessary. Convalescence can be very good, especially if there were no long-term or major neurological disorders before surgery .
- Brain tumor: The tumor and surrounding bleeding may need to be removed . However, when there are many tumors in the brain, surgery may not be acceptable and radiation therapy may be considered instead .
- Brain aneurysm: repair of the aneurysm may be necessary. It is a complex neurosurgical procedure that, in some situations, can be performed using a minimally invasive technique.
- Edema – A decompressive hemicraniectomy involves the temporary removal of part of the skull to relieve pressure caused by excessive swelling. As soon as the tumor subsides, the removed part of the skull is returned to its place .
In addition to surgery, medical attention is often required. You may need IV fluids with a carefully controlled sodium concentration to avoid additional swelling.
After immediate treatment for brain hemorrhage, you may need physical therapy or a speech therapist . People recovering from a brain hemorrhage often need help with self-care and may need to relearn how to eat, talk, or walk.
Recovery can take a long time. Recovery can take up to a year, and many people only partially recover. Rehabilitation after a brain bleed is similar to rehabilitation after a stroke .
Don't expect it to bleed again after you've recovered from a brain bleed.
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There are several types of brain bleeds, and although they are dangerous, recovery is possible. If you come across someone who shows signs of a brain hemorrhage, seek help immediately. Getting emergency care is the best way to improve your outcome.