Brain Haemorrhage (Intracranial Haemorrhage)

Brain bleeds, regardless of location, usually happen suddenly. (However, some – for example, subdural hematomas – can take days to weeks before symptoms develop.) 

Oxygen supply to the brain is affected by leaky or burst blood vessels or increased pressure on the brain as blood pools. This can cause brain damage and can be life-threatening. The seriousness and outcome of a brain bleed depends on its cause, location inside the skull, size of the bleed, the amount of time that passes between the bleed and treatment, as well as age and overall health. 

Symptoms of a brain haemorrhage depend on the area of the brain involved, and can include:

• Sudden tingling, weakness, numbness, or paralysis of the face, arm or leg, particularly on one side of the body
• Headache (Sudden, severe “thunderclap” headache occurs with subarachnoid haemorrhage)
• Nausea and vomiting
• Confusion
• Dizziness
• Seizures
• Difficulty swallowing
• Loss of vision or difficulty seeing
• Loss of balance or coordination
• Stiff neck and sensitivity to light
• Abnormal or slurred speech
• Difficulty reading, writing or understanding speech
• Change in level of consciousness or alertness, lack of energy, sleepiness or coma
• Trouble breathing and abnormal heart rate (if bleed is in the brainstem)

Bleeding in the brain has several causes, including:

• Head trauma, caused by a blow to the head from a fall, accident or assault
• High blood pressure (hypertension), which can damage the blood vessel walls and cause the blood vessel to leak or burst.
• Build-up of fatty deposits in the arteries (atherosclerosis).
• Blood clot, either formed in the brain or travelled to the brain from another part of the body, which damaged the artery and caused it to leak
• Ruptured cerebral aneurysm (a weak spot in a blood vessel wall that balloons out and bursts)
• Build-up of amyloid protein within the artery walls of the brain (cerebral amyloid angiopathy)
• A leak from abnormally formed connections between arteries and veins (arteriovenous malformation)
• Bleeding disorders or treatment with anticoagulant therapy (blood thinners)
• Brain tumour 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 haemorrhage
• 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

A suspected brain haemorrhage is a medical emergency requiring immediate assessment. The sooner a diagnosis can be made, and treatment started, the better the chance of survival.

Diagnosis is usually made based on the results of:

• Evaluation of physical symptoms
• CT scan or magnetic resonance angiogram (MRA) of the brain to determine the location, extent and sometimes the cause of the bleed

Other tests may include:

• Electroencephalogram (EEG) to measure electrical activity in the brain
• Chest X-ray
• Vascular study – uses ultrasound to assess flow in blood vessels
• Testing the blood or urine for abnormalities
• Spinal tap to examine the cerebrospinal fluid that surrounds the brain.
• In some cases, conventional angiography may be done to identify an aneurysm or arteriovenous malformation

Prompt medical treatment can help limit damage to the brain, which will improve your chance of recovery.

Treatment depends on the size, cause and location of the bleed and other factors.

Surgery may be needed in the following situations:

• Decompression of the brain to release pooled blood and relieve pressure, either through a small burr hole or a larger opening in the skull
• A cerebral aneurysm that has not ruptured may require clipping or filling (“sealing off”) to prevent a future rupture
• An arteriovenous malformation (AVM) that has not ruptured is treated by direct removal of the AVM through surgery, use of computer-guided radiation to close off the abnormal vessels or use of a special glue or other filler to block the blood flow from smaller blood vessels into the AVM or the vessels that supply the AVM

Medications may include:

• Anti-anxiety drugs and/or medication to control blood pressure
• Anti-epileptic drugs for seizure control
• Other medications needed to control other symptoms, such as painkillers for severe headache and stool softeners to prevent constipation and straining during bowel movements.

Long-term rehabilitation may be required, including:

• Physical therapy
• Speech therapy or alternative forms of communication.
• Occupational therapy
• Changing lifestyle habits to reduce risk of another haemorrhage

Steps you can take to reduce your risk of a brain haemorrhage include:

• Control your blood pressure.
• Lowering your cholesterol level.
• Lose excess weight.
• Limit alcohol and stop smoking
• Eat a healthy diet
• Get regular exercise
• Control blood sugar levels if you have diabetes