Sunday, May 22, 2022

What Is A Brain Bleed

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Intracranial Hemorrhage In Babies

Intracranial hemorrhage is a broad term used to describe bleeding that occurs inside the skull. When bleeding is found around or inside the brain, a more specific term, cerebral hemorrhage, is used.

Hematoma is a word youll often see used as a synonym for hemorrhage, although the two conditions are slightly different. Hemorrhage refers to bleeding in general, any time blood escapes from the circulatory system. Hematoma, on the other hand, is a collection of blood outside the circulatory system. Hemorrhage leads to hematoma, but not in all cases.

Brain bleeds are classified by where they occur:

  • epidural hematoma bleeding between the skull and the dura mater, the first of several membranes surrounding the brain
  • subdural hematoma  bleeding between the brain and the dura mater
  • subarachnoid hemorrhage bleeding between the brain and the pia mater, a thin layer of tissues closest to brain tissue
  • intraparenchymal hemorrhage bleeding inside brain tissue itself
  • intraventricular hemorrhage bleeding inside the ventricles, channels within the brain that produce cerebrospinal fluid

Image courtesy of National Institutes of Health.

Intracranial hemorrhage is particularly common in babies with a low-birth weight and premature babies, who have blood vessels that havent fully developed yet.

Complications Of Internal Bleeding In Brain

Only a few lucky patients have a near normal life after brain Heamorrhage. This is mostly seen with a very small amount of bleeding.

Usually, these patients develop paralysis of either single upper limb or single lower limb or Unilateral hemoplegia. These patients need physiotherapy for the lifetime.

Recovery chances are higher in brain hemorrhage when the patient is young, having smaller bleed and reach to the hospital within the first hour.

What Are The Risk Factors For A Thunderclap Headache

People with certain inherited conditions such as weak blood vessels or a tendency to develop blood clots have a higher risk of thunderclap headaches.

Some people with high blood pressure may be more likely to experience thunderclap headaches. These people may be at higher risk of having a blood vessel rupture in the brain.

For some people, activities such as heavy exertion and sexual activity can trigger thunderclap headaches. Once you identify these triggers, avoiding them can help reduce the number of headaches you experience. Your doctor can provide treatment options, including medications, to reduce your likelihood of repeated thunderclap headaches.

Brain Aneurysm: What Happens During A Brain Hemorrhage

The skull protects the brain, but it also limits the amount of available space: Bleeding inside the skull quickly increases the pressure on the brain tissue. This often leads to serious complications.

A brain hemorrhage is bleeding in the brain that occurs when blood vessels inside the skull are damaged, for instance due to a major head injury. Other causes include problems with blood clotting and/or damage to the blood vessels in the brain due to thickened and hardened artery walls or high blood pressure, for example. The bleeding is often caused by a ruptured brain aneurysm. A brain aneurysm is a bulge in an artery in or near the brain.

Risk Factors For Strokes From Brain Bleed

Brain hemorrhage: causes, symptoms, and treatment.

Here are the risk factors for a hemorrhagic stroke:

  • High blood pressure: Uncontrolled high blood pressure is the most important risk factor for a stroke from brain bleed. Your risk of brain bleed goes higher as your blood pressure goes up.
  • Smoking: Smoking greatly increases your risk of having a stroke from brain bleed. The risk seems to go down slowly after you quit smoking. Taking care of high blood pressure and quitting smoking are the two most important things you can do to prevent a hemorrhagic stroke.
  • Alcohol abuse: Heavy drinking has been identified as an important risk factor for a stroke from brain bleed.
  • Blood thinners: People who are on blood thinners for a history of blood clots or other conditions are at an increased risk of having a stroke from brain bleed. In most cases when blood thinners are required, the risk of not taking blood thinners is higher than the risk of getting brain bleed. It is important to understand the risks and benefits of taking blood thinners for any medical condition.
  • The use of aspirin and similar medications for the prevention of regular strokes or heart attacks: Aspirin and similar medications prevent platelets from sticking to the arteries and help prevent the formation of plaques that may lead to heart attacks or strokes . Platelets are small particles in the blood that stick together to help make blood clots. When platelets are ineffective, you can have an increased risk of bleeding, including bleeding in the brain.
  • Contacting A Personal Injury Attorney

    If a loved one has suffered a brain injury in a traumatic accident, such as a motor vehicle collision or a slip and fall incident, this can be a stressful process. Families often have many questions about how the incident occurred. In this scenario, it is important to meet with a traumatic brain injury lawyer. There are many ways an attorney can help, such as:

    • Taking a look at the records of the accident to ensure that details havent been overlooked.
    • Serving as an objective presence to help families make decisions during a difficult time.
    • Assisting families to seek damages that are related to the accident.
    • Taking the case to court when necessary.

    No family should ever feel alone following a serious accident, particularly one with major injuries. This is why reaching out to a traumatic brain injury attorney in San Francisco is a good idea. You could be entitled to a financial reward.

    Infant Brain Bleed Causes

    Many newborns experience some form of brain bleeding after birth, even after normal vaginal deliveries. In the vast majority of cases, blood vessels will heal in time, the bleeding will stop and the child will continue to develop normally.

    Severe bleeding events, however, can lead to life-long disabilities, including neurological impairment and developmental delay. These serious forms of brain bleeding are more likely to be caused by mechanical head trauma. Assisted deliveries are a particular risk and doctors must use incredible care with forceps or vacuum extractors to prevent serious harm.

    While severe brain bleeding in newborns is relatively rare, mechanical trauma is surprisingly common. Every year, an estimated 32,000 newborns sustain birth injuries due solely to physical trauma, according to Medscape. Researchers continue to debate the causal factors associated with birth injury, but some experts believe that at least half of these traumatic injuries are potentially avoidable.

    What To Expect When Your Loved One Develops Brain Bleed While Being Hospitalized For A Stroke

    It is important to understand that brain bleed after a stroke is not always a disaster. If your loved one received timely treatment for a stroke and was doing better with improved symptoms, small brain bleed seen on a CT scan may not be significantly worse.

    Any new brain bleed after a stroke requires close monitoring in the hospital. If your loved one was being treated on a regular floor of the hospital, you can expect to him or her to be moved to the ICU for closer monitoring. They will watch out for signs of increased pressure inside the brain. Worsening headaches, nausea, or vomiting may signal high pressure inside the brain, and could be cause for concern.

    Large brain bleed after a stroke can be very difficult to treat and has a worse outcome. They can sometimes try to treat the bleeding by giving medications to reverse the clot-busting medications used in the treatment of the initial stroke. They can also transfuse platelets to see if that would help prevent any further bleeding. However, large brain bleed has a very poor outcome, and only a small percentage of people with large brain bleed after a stroke survive.

    Some patients with brain bleed after a stroke may benefit from surgery. Patients who have moderate-sized bleeding along with increased pressure inside the brain might do better if that pressure can be surgically relieved. Neurosurgeons have several different surgical techniques they can use to try to achieve that goal. It only works in a few patients.

    Diagnosing A Brain Bleed: Traumatic Brain Injury

    When an individual is involved in a traumatic accident, countless injuries might result. Some of these injuries can be relatively minor, such as bumps, bruises, and cuts. Others can be devastating, life-altering injuries. This is what happens when someone has suffered a traumatic brain injury . Unfortunately, thousands of families are irreparably damaged every year because of a brain injury suffered by a loved one. According to the Centers for Disease Control and Prevention :

    • The most common causes of traumatic brain injuries included slip and fall injuries and auto accidents in 2013.
    • About 75 percent of all traumatic brain injuries in elderly individuals resulted from falls.
    • Between 2001 and 2012, the rate of hospitalizations for traumatic brain injuries in children doubled.

    Based on these numbers, it is obvious that neurological injuries are a serious issue. Like other injuries, there are many different types of brain damage. One common example is an intracranial hemorrhage, which is also called a brain bleed.

    How Is Ich Diagnosed

    The first step your doctor will take to diagnose ICH is a CT scan of your head. A CT scan can show abnormalities in your brain like swelling or clots.

    The CT scan may not show any sign of ICH. If youre still having symptoms, your doctor may choose to perform a lumbar puncture, or spinal tap, to test the fluid that cushions your spine and brain.

    Why Is A Subarachnoid Hemorrhage Life

    If a brain aneurysm ruptures or an artery that passes over the surface of the brain bursts, blood flows into the fluid-filled space around the brain. Doctors call this area the “subarachnoid space.” Bleeding into this space is called a subarachnoid hemorrhage.

    Blood can then quickly spread in this space and put pressure on the whole brain. This means that even parts of the brain that aren’t very close to the bleeding blood vessel are damaged. The bleeding quickly causes a severe headache. Left untreated, it often leads to unconsciousness and life-threatening complications like an irregular heartbeat and respiratory arrest .

    The brain damage can cause long-term or permanent problems in everyday life, or lead to the need for nursing care for instance because of speech problems or paralysis.

    Different types of bleeding in the brain

    Treatment For Subarachnoid Haemorrhage

    • Surgery – surgery can only be used if the cause of the subarachnoid haemorrhage is clear, such as an aneurysm or arteriovenous malformation.
    • Conservative treatment – neurosurgery is not an option if there is no definable cause, however drainage of the blood from the subarachnoid space is usually performed. Then careful observation is carried out for a specified period of time to ensure there is no further damage to the brain. This course of action may also be taken if the haemorrhage is too large or too risky to operate on.

    How The Treatment Of An Ischemic Stroke May Lead To Brain Bleed

    What Is a Brain Bleed and What Causes It?

    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.

    Emergent Treatment Is Required

    As time passes, the bleed will continue to grow. As the bleed gets bigger, it starts to fill the space inside of the skull. This means that the intracranial pressure rises and the individual could suffer a brain herniation. The symptoms of a brain herniation include:

    • A pupil that is significantly larger than the other called a blown pupil.
    • A rising heart rate and falling blood pressure.
    • Paralysis of the arms and legs.
    • The loss of a respiratory drive, leading to a cessation of breathing.

    To prevent this, a doctor needs to relieve the intracranial pressure. A trained neurosurgeon will perform an emergent craniotomy, removing a part of the skull to allow the brain to swell without the constriction of rising pressure. This treatment could be lifesaving.

    Watch YouTube Video: Diagnosing Brain Hemorrhages. In the video below, Dr. Max Wintermark from the University of Virginia explains how to diagnose traumatic brain injuries.

    Understanding And Recognizing Brain Bleeding And Contusions

    Brain hemorrhages after accidents are not uncommon. Intracranial bleeding can occur between the brain and skull, brain layers, or between the brain and its membranes. The initial trauma generally irritates and damages blood vessels in the brain, causing cerebral edema . This swelling may then compress and damage additional blood vessels resulting in further bleeding. The blood can also pool into hematomas, reducing blood flow and killing brain cells. Strokes occur when the bleeding involves a major brain artery and subsequent blockage.

    Patients often develop symptoms of brain bleeds suddenly. The most common symptoms of brain bleeding include:

    • Sudden and painful headaches
    • Inability to read, write, speak, or effectively communicate
    • Loss of coordination and balance
    • Nausea and vomiting
    • General lack of awareness

    Many traumatic brain injuries cause immediate brain trauma and swelling, meaning TBI symptoms and brain bleeding often overlap. Traumatic brain injuries that initially seem mild generally result in slower bleeds that increase pressure over time. If patients go home and their symptoms suddenly worsen, they may be having a traumatic stroke. Sharp and painful headaches, along with confusion, are often the first signs of brain bleeding. However, the symptoms often depend on the bleeds location. If you recently suffered from brain trauma and begin experiencing different or worsening symptoms, seek emergency medical help immediately.

    How Is A Thunderclap Headache Diagnosed

    Doctors usually diagnose thunderclap headaches with an imaging test called a CT-Angiogram scan. This test shows a doctor the blood vessels in and around the brain to see what is causing the pain.

    Sometimes doctors take a sample of spinal fluid from the back in a test called a spinal tap. This test enables doctors to see if there is blood in the spinal fluid to help determine the cause of the headache.

    Magnetic resonance imaging , another type of imaging test, may be ordered if the CT and spinal fluid are normal.

    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.

    The Basics About Brain Bleeds / Hemorrhages

    A hematoma is a collection of blood outside the brain. A subdural hematoma results from blood collecting between the outermost layer of the brain, also known as the dura, and the next layer called the arachnoid. An epidural hematoma refers to the bleeding between the dura matter and the skull. Hematomas can result in excess pressure and/or swelling of the brain, and in the worst cases can lead to death.

    What Are The Complications Of Having A Subdural Hematoma

    Without treatment, large hematomas can lead to coma and death. Other complications include:

    • Brain herniation: Increased pressure can squeeze and push brain tissue so it moves from its normal position. A brain herniation often leads to death.
    • Repeated bleeding: Older adults who are recovering from a hematoma have a higher risk of another hemorrhage. Older brains dont recover as quickly as younger brains. Also, as we age, our brains shrink and the space between the skull and brain widens. This further stretches the tiny thin veins between the outer membrane layers of the brain and skull and makes the older brain more vulnerable to future bleeding if another head injuries occur.
    • Seizures: Seizures may develop even after a hematoma has been treated.

    What Is A Haemorrhagic Stroke

    In the UK, around 15% of strokes are haemorrhagic , and about 85% are ischaemic .

    Haemorrhagic stroke tends to affect younger people than ischaemic stroke, and is most common in people aged between 45 and 70. Most strokes in the UK happen over the age of 70.

    There are two main types of haemorrhagic stroke:

    • Bleeding within the brain: called an intracerebral haemorrhage, or intracranial haemorrhage .
    • Bleeding on the surface of the brain: called a subarachnoid haemorrhage .

    Bleeding within the brain

    When an artery inside the brain bursts it’s called an intracerebral haemorrhage. About 10% of all strokes are of this type. 

    The blood leaks out into the brain tissue at high pressure, killing brain cells and causing brain swelling.Bleeding on the surface of the brain

    The brain sits inside a fluid-filled cushion of membranes that protects it from the skull, called the subarachnoid space. If blood vessels near the surface of the brain burst and blood leaks into the subarachnoid space, this is called a subarachnoid haemorrhage .

    SAH accounts for around 5% of all strokes, and it is most often caused by a burst aneurysm .

    Subarachnoid haemorrhage can run in families. If you have had an SAH and are concerned that this might affect your own family, speak to your GP. They can help you understand the causes of your stroke and the risks for your family members. 

    How Does A Brain Bleed Affect A Patient

    HealthOpinion: Early Signs That Help You Spot Brain Hemorrhage

    As mentioned previously, in the worst cases of brain bleeding, the result could be death. This is of course dependent on the severity of the bleed. Minor bleeding may not cause any significant or visible health challenges, and may not affect the lifespan of the individual. Where the bleed is located within the brain, as well as when it is detected and subsequently treated, may be determining factors of survival.

    How The Size And Location Of Brain Bleed After A Stroke Makes A Difference In The Final Outcome

    Not all brain bleed after strokes cause a worse outcome than the original stroke. In fact, small amounts of blood leaking out after a stroke may be a sign that blood is flowing again in that part of the brain, signaling a better outcome. Many small brain bleeds after strokes may go undetected, because patients may not feel any worse with brain bleed than how they felt with the initial stroke.

    In general, if the bleeding occupies 30% or more of the area of the brain affected by the stroke, the outcome will likely be worse. The larger the bleeding, the worse the expected outcome can be.

    The location of the brain bleed and whether it is pushing on the surrounding brain tissue also makes a significant difference in the outcome. When the bleeding is in a confined area, it generates higher pressure and pushes on a part of the brain not affected by the initial stroke. That can lead to worsening symptoms, as the previously normal part of the brain begins to deteriorate with pressure.

    What Is A Brain Aneurysm

    A brain aneurysm is a bulge in a weak area of a blood vessel in or around your brain. The constant pressure of blood flow pushes the weakened section outward, creating a blister-like bump.

    When blood rushes into this bulge, the aneurysm stretches even further. Its similar to how a balloon gets thinner and is more likely to pop as it fills with air. If the aneurysm leaks or ruptures , it causes bleeding in your brain. Sometimes it causes a hemorrhagic stroke, bleeding in or around the brain that can lead to brain damage and be fatal.

    These aneurysms are also called cerebral aneurysms. Cerebral means in the brain.

    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
    • 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.

    Risk Factors For Brain Hemorrhage

    The most common risk factor for brain hemorrhage is hypertension 18). Antiplatelet 19) and anticoagulant medications also increase the risk of spontaneous brain hemorrhage. Cerebral amyloid angiopathy is related to build-up of amyloid proteins in arterial walls, making them more susceptible to rupture. Hemorrhages due to cerebral amyloid angiopathy are typically lobar , multiple, and occur in patients at least 55 years of age 20).

    The rupture of an intracranial aneurysm may be spontaneous, precipitated by exertion, or from hypertension. About 12% of the adult population harbors an unruptured intracranial aneurysm 21), but only about 1% of these rupture, and how best to select patients for prophylactic aneurysm obliteration is unsettled 22). The most important modifiable risk factors are tobacco use, hypertension, and cocaine use 23); nonmodifiable risk factors include a personal history of subarachnoid hemorrhage, familial history of subarachnoid hemorrhage 24), larger aneurysm size 25), female sex 26), connective tissue disease, and older age. Arteriovenous malformations are often congenital and may become symptomatic later in life.

    Other Types Of Bleeding

    Blood can also leak into the small gaps between the meninges or between the meninges and the skull:

    • If veins in the brain are damaged, for example as a result of a fall, blood may leak into the space between two meninges known as the arachnoid mater and the dura mater. The medical term for this kind of bleeding is subdural hematoma.
    • If an artery that supplies the meninges with blood is damaged, bleeding known as an epidural hematoma may occur. The blood then leaks into the space between the skull bone and the tough membrane covering the brain .

    Like other types of bleeding in the brain, subdural and epidural hematomas can cause severe brain damage.

    Common Causes Of A Brain Bleed

    Brain bleeds can be incredibly dangerous and they can occur just about anywhere within your cranial cavity. Here are some of the conditions main causes:

  • The most common way that brain bleeds occur is through an injury or some form of physicalhead trauma.
  • Another very common cause ishigh blood pressure, which can weaken the blood vessel walls within your brain. This is one of the most preventable causes that can be easily treated.
  • Ananeurysmis when a blood vessel wall in the brain swells, weakens and then eventually bursts into the brain creating a stroke.
  • Also bleeding or blood disorders likesickle cell orhemophilia can create brain bleeds.
  • Lastly liver disease and brain tumors are major causes associated in general with increased bleeding.
  • What Recovery Can I Expect After A Brain Hemorrhage

    Besides depriving the brain of oxygen and killing brain cells, bleeding inside the brain also prevents nerve cells from communicating with the parts of the body and the functions they control. This results in a loss of memory, speech or movement in the affected area.

    Depending on the location of the hemorrhage, the extent of damage and your age and overall health, there can be lasting effects from a brain bleed. These affects can include:

    • Inability to move part of the body .
    • Numbness or weakness in part of the body.
    • Difficulty swallowing.
    • Difficulty speaking or understanding spoken or written words.
    • Confusion, memory loss or poor judgment.
    • Personality change and/or emotional problems.
    • Seizures.
    • Headaches.

    However, over time and with a lot of effort and determination in rehabilitation , you can regain some of these lost functions. This is especially true if your general health is otherwise good.

    Unfortunately, some patients who remain in a coma, or have been severely paralyzed after an intracranial or cerebral hemorrhage may need permanent, long-term care typically provided in a nursing home. Depending on the type, location and extent of the brain bleed, many patients do not survive the initial bleeding event.

    Last reviewed by a Cleveland Clinic medical professional on 05/04/2020.

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