What Happens When A Brain Bleeds
I’ve been hearing about bleeding in the brain after a TBI. Can you explain how this happens and why it’s so dangerous? What exactly is a subdural hematoma?
Let’s start with the basics. A hematoma is a tumor-like collection of blood, usually clotted, located outside a blood vessel. The subdural space is located between the dura mater and the arachnoid membrane . The epidural space is located on or outside the dura mater.
Now, to answer your question, a subdural hematoma is basically bleeding into the space between the brain cover and the brain itself. More specifically, there are blood vessels running through the brain and in the spaces between the outside of the brain and the inside of the skull. During a brain injury, any of these vessels can tear and bleed. Ruptured vessels running in the subdural space typically veins cause subdural hematomas. Ruptured vessels running through the epidural space typically arteries cause epidural hematomas. Both types of bleeding take up space in the skull and in so doing squeeze down on the brain. Because arteries are under pressure, epidural hematomas leak quickly and compress the brain rapidly while subdural hematomas leak much more slowly.
Getting to the hospital quickly is the best way to diagnose and treat this bleeding, which usually requires surgery to remove the blood and relieve the pressure on the brain.
How Is Intracerebral Hemorrhage Diagnosed
If you have some symptoms of ICH, a doctor will perform a neurological exam. Imaging tests determine if youre having an ischemic stroke or a hemorrhagic stroke .
Diagnostic testing for ICH may include a CT scan. This type of test creates images of your brain, which can confirm bleeding, and also assess for other evidence of trauma to your head.
An MRI scan may help your doctor see your brain more clearly to better identify the cause of the bleeding.
An angiogram uses X-ray technology to take pictures of blood flow within an artery, and can reveal any abnormalities with the blood vessels themselves, such as aneurysms or arteriovenous malformations.
Blood tests can identify immune system disorders, inflammation, and blood clotting problems that can cause bleeding in your brain.
Depending on the location of the hemorrhage and how long your brain was without oxygen, complications may include:
- impaired language skills
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When Should I Call The Doctor Or Seek Emergency Care
Go to the emergency room if you are experiencing a thunderclap headache for the first time. It is urgent to determine if a dangerous condition is the underlying cause so it can be treated quickly if necessary. Some conditions associated with a thunderclap headache can be fatal without prompt treatment.
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Diagnosis Of Subarachnoid Haemorrhage
- CT scan – identifies the extent of the subarachnoid haemorrhage and can sometimes pinpoint the location of the bleed. A CT scan can identify complications of a subarachnoid haemorrhage, such as communicating hydrocephalus.
- Lumbar puncture – CSF is removed using a needle and examined for the presence of blood.
- Intra-arterial digital subtraction angiography – also known as cerebral angiography. This is the most commonly used radiological procedure to locate the cause of an aneurysmal subarachnoid haemorrhage.
- MRI scan – this non-invasive scan uses strong magnetic fields to visualise brain blood vessels and their associated abnormalities.
Bleeding In The Brain Due To Haemorrhagic Stroke
Most acute strokes are due to a blockage in one of the arteries that bring oxygenated blood into the brain. These are usually caused by atherosclerosis, which narrows the arteries and leads to an ischaemic stroke.
Around 15 in every 100 people who have a stroke do so because one of the blood vessels in their brain bursts, releasing blood into the brain tissue. This event is a haemorrhagic stroke and it can also be called an intracerebral haemorrhage the spill of blood that it causes is an intracerebral hematoma.
The symptoms of a haemorrhagic stroke are similar to those of an ischaemic stroke but the treatment needed is quite different. Clot busting drugs and anticoagulants are used to help unblock a blood vessel if someone has had an ischaemic stroke but this would be highly dangerous in someone who has bleeding in the brain.
This is why it is important for anyone admitted to hospital with a stroke to undergo a CT scan or MRI scan very quickly. These imaging techniques can show which type of stroke has taken place. For someone who has had a haemorrhagic stroke, the best treatment is usually emergency surgery to stop the bleeding in the brain and to get rid of the blood that has spilled into the brain tissue.
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Symptoms Of Brain Bleeds
There are manifold symptoms to understand the brain bleeds. People going unconscious, can be a single symptom. Brain bleeds symptoms can vary from individual to individual as per the location of the brains damaged tissues. However, the doctors suggest some prime brain bleeds symptoms which can help us identify whether they are suffering from brain bleeds.
- Abnormal pulse rate and heartbeat
- Breathing trouble
- Status of unconsciousness and coma
- Inability to swallow
- Feeling paralysis in the limbs and the face, even permeating to half of the body
- Cranial nerve palsies or
- Incessant perspiring
- Numbness in certain body parts
- Sleepiness, lethargy, and apathy
Causes Of Bleeding In The Brain
Head trauma: This common cause of disability may start with something as seeminglyharmless as a bump on the head, but it could result in serious brain damage if it causes a brain bleed. The American Association of Neurological Surgeons estimates that 1.7 million cases of traumatic brain injury occur every year nationwide, so it is critical to protect the head, especially for children, whose brains are still developing. If you ride a motorcycle or play contact sports, it is critically important to wear a helmet to protect your head and prevent injury.
High blood pressure: Untreated hypertension is the most common cause of brain bleeds. Brain arteries begin to weaken as excess force of the blood against the walls of your arteries can cause a brain bleed.
Ruptured brain aneurysm: This is caused by a weak spot in a blood vessel ballooning out and bursting.
Bleeding disorders: Conditions such as hemophilia or sickle cell anemia can contribute to a brain bleed.
Blood vessel abnormalities, or arteriovenous malformations : This rare cause of brain bleeds is due to a group of blood vessels in the brain not forming correctly before birth. It can cause leaking of the arteries or veins.
Drug abuse: Cocaine and other illicit drugs can weaken the blood vessels, leading to brain bleeding. Some prescription drugs also increase the risk of a brain hemorrhage.
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Bleeding In The Brain Due To A Brain Aneurysm
A brain aneurysm is another blood vessel problem that is caused by atherosclerosis. Fats and debris build up on the inner surface of the arteries, causing them to become less elastic and the walls weaken. This often happens in older people and tends to affect blood vessels throughout the body. People who have atherosclerosis also have high blood pressure, and this causes the artery to balloon out at the point where it is weakest.
A brain aneurysm doesnt always burst it can grow to a certain size and then remain there, or it can grow. Small and large aneurysms can burst and the degree of damage to the brain depends on the quantity of blood released, which part of the brain is affected, and how quickly treatment can be given. People can show symptoms if they have a brain aneurysm that hasnt burst and imaging techniques can then be used to monitor the aneurysm regularly.
The usual treatment is then planned surgery or a technique called endovascular coiling, where a coil is placed into the aneurysm through one of the main veins. A burst aneurysm leads to the same effects as a haemorrhagic stroke and usually needs emergency treatment.
What Is A Thunderclap Headache
A thunderclap headache is an extremely painful headache that comes on suddenly, like a clap of thunder. This type of headache reaches its most intense pain within 1 minute and lasts at least 5 minutes.
Thunderclap headaches strike without any warning. Some of these headaches are benign . But they can also be a sign of very serious underlying conditions that involve bleeding in and around the brain.
It is important to seek medical attention immediately to rule out life-threatening causes of a thunderclap headache.
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What Does Rehabilitation After A Brain Bleed Entail
The goals of long-term treatment are to help you regain the functions needed for daily living, as much and as soon as possible, and to prevent future brain hemorrhages. Rehabilitation and recovery time vary according to each persons unique brain bleed and the extent of rehabilitation possible.
Long-term rehabilitation treatment may include:
- Physical therapy.
- Control blood sugar levels if you have diabetes.
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.
- Donât smoke.
- Donât 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, 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 Coumadin. If you take this blood-thinning drug, also called warfarin, follow up regularly with your doctor to make sure your blood levels are in the correct range.
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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. 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.
How Do Doctors Diagnose A Brain Hemorrhage
If any kind of stroke is suspected, immediate evaluation is needed. Examination may reveal evidence of brain injury with weakness, slurred speech, and/or loss of sensations. Generally, a radiology examination is necessary, such as a computed tomography scan or magnetic resonance imaging scan. The CT or MRI can highlight various features and location of brain bleeding. If bleeding inside of or around the brain is noted, further testing may be ordered to try to determine the cause of the bleeding. This additional testing can help to determine if abnormal blood vessels are present as well as the next step in either diagnosis or treatment. In certain situations, a spinal tap may be required to confirm evidence of bleeding or rule out other brain problems.
Patients with bleeding inside of the brain must be monitored very closely. Early treatment includes stabilizing blood pressure and breathing. A breathing assist machine can be required to ensure that enough oxygen is supplied to the brain and other organs. Intravenous access is needed so that fluids and medications can be given to the patient, especially if the person is unconscious. Sometimes specialized monitoring of heart rhythms, blood oxygen levels, or pressure inside of the skull is needed.
Various medications may be used to help decrease swelling around the area of the hemorrhage, to keep blood pressure at an optimal level, and to prevent seizure. If a patient is awake, pain medication may be needed.
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How The Treatment Of An Ischemic Stroke May Lead To Brain Bleed
When we look at what causes bleeding after a stroke, it is easy to see why the treatment of an ischemic stroke may lead to brain bleed. The goal of treatment of a regular stroke is to get rid of the blockage and get blood flowing again into the part of the brain affected by the stroke. If the blood gets there after the walls of the blood vessels have already been damaged, there is a risk of them bleeding into the brain.
The risk of brain bleed goes up as the time needed to successfully restore the blood flow gets longer. As more time passes, the part of the brain without blood gets more damaged and more likely to have blood vessels with damaged walls. The risk of brain bleed after treatment is one of the reasons why it is important to call 911 as soon as you suspect a stroke. If they are able to get the blood flowing again within 3 hours, the risk of brain bleed after treatment is low.
Emergency Treatment For A Hemorrhagic Stroke
Immediate emergency care is crucial for a hemorrhagic stroke. This treatment focuses on controlling the bleeding in your brain and reducing the pressure caused by the bleeding.
Drugs can be used to reduce blood pressure or slow down the bleeding. If you experience a hemorrhagic stroke while on blood thinners, youre at particular risk for excessive bleeding. Drugs to counteract the effect of the blood thinners are usually given right away during emergency treatment.
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Brain Bleeds In Elderly
Brain hemorrhage has been very common in elderly persons. The WHO survey illustrates that the older adults who go for routine exercise are less likely to get brain bleeds. They keep the brain strength by balancing work pressure and family life. The extra protein is broken down while doing the routine practice. Those who do not do daily exercise, 90% are more likely to get brain bleeds. As people age, so also the amyloid protein in the blood vessels, they cause damage to the walls leading to brain bleeds with a shock or mental distress. Keep yourself safe from brain strokes by doing necessary physical exercise.
How Is Subarachnoid Hemorrhage Diagnosed
If you have symptoms of a subarachnoid hemorrhage, a doctor might use several tests to diagnose it:
MRI scan. This test uses large magnets, radiofrequency energy, and a computer to make detailed images of the brain.
CT scan. This test uses X-rays and computer technology to make horizontal, or axial images of the brain. CT scans are more detailed than general X-rays.
Angiogram. During this test, dye is injected in the blood vessel and then X-rays are taken to evaluate blood flow through them.
Spinal tap. In this test, a special needle is placed into the lower back, into the spinal canal. The pressure in the spinal canal and brain can be measured. A small amount of cerebrospinal fluid can be removed and analyzed for the presence of blood
A diagnosis of a cerebral aneurysm isn’t usually made until a subarachnoid hemorrhage has already occurred.
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Is Brain Bleed Always A Stroke
No, certainly not.
There are many different types of brain bleed. Strokes from brain bleed are a special kind of brain bleed. Medically, it is known as a hemorrhagic stroke. Brain bleed caused by a car accident, bleeding around the brain, or bleeding under the skull are other types of brain bleed that are not an actual hemorrhagic stroke.
Bleeding after a regular stroke is also different than a stroke from brain bleed. You can read this article if you would like to understand how brain bleed can happen after a stroke.
When Should I Call My Healthcare Provider
The sooner the bleeding in the brain is controlled, the better the outlook. It’s important to seek emergency medical attention if you have any signs of a subarachnoid hemorrhage such as:
Severe headache the worst headache pain that you have ever had
Nausea and vomiting with the headache
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What Are The Causes Of Brain Bleeds
Bleeding in the brain has a number of causes, including:
- Head trauma, caused by a fall, car accident, sports accident or other type of blow to the head.
- High blood pressure , which can damage the blood vessel walls and cause the blood vessel to leak or burst.
- Buildup of fatty deposits in the arteries .
- Blood clot that formed in the brain or traveled to the brain from another part of the body, which damaged the artery and caused it to leak.
- Ruptured cerebral aneurysm .
- Buildup of amyloid protein within the artery walls of the brain .
- A leak from abnormally formed connections between arteries and veins .
- Bleeding disorders or treatment with anticoagulant therapy .
- Brain tumor that presses on brain tissue causing bleeding.
- Smoking, heavy alcohol use, or use of illegal drugs such as cocaine.
- Conditions related to pregnancy or childbirth, including eclampsia, postpartum vasculopathy, or neonatal intraventricular hemorrhage.
- Conditions related to abnormal collagen formation in the blood vessel walls that can cause to walls to be weak, resulting in a rupture of the vessel wall.