Brain Hemorrhage - Symptoms, Types, Causes, Complications, Treatment
Brain hemorrhage definition
Brain hemorrhage, also called brain bleed or intracranial hemorrhage, is a type of stroke caused by the bursting of an artery in the brain, resulting in bleeding in the surrounding tissues. The symptoms of a brain hemorrhage differ based on the amount of tissue injured, the location of the bleeding, and the severity of the bleeding.
It is a life-threatening condition that can be handled with intensive care to improve the outcome. Intracranial hemorrhage can occur spontaneously, as a result of trauma, an underlying vascular abnormality, or as a side effect of anticoagulant medication. A
neurologist or neurosurgeon usually recommends a
computed tomography (CT) scan and a magnetic resonance imaging (MRI) scans to check for internal bleeding or blood accumulation and to treat it accordingly.
Brain hemorrhage meaning
Brain hemorrhage is the combination of two words in which
- The word “brain” is a derivation from Old English “braegen," which originated from the Proto-Germanic source “bragnan” (source also of Middle Low German bregen, Old Frisian, and Dutch brein). All the derivations describe it as a “soft, greyish mass which fills the cranium of any vertebrate."
- The term hemorrhage is derived from the Greek word "haimorrhagia," which originated from the words "haima" (blood) and "rhagē," which means "a breaking, gap, cleft," from the word "rhēgnynai," which means "to break, burst."
Brain hemorrhage statistics
Prevalence of brain hemorrhage in the world
The prevalence of brain hemorrhage, particularly intracerebral hemorrhage (ICH), varies considerably across areas and populations around the world. A systematic review of 52 studies, including more than 2.3 crore participants, found that the global incidence of ICH is around 29.9 per 100,000 person-years (95% CI: 26.5-33.3). This suggests that the incidence rate has been stable over the last several decades. Men are often more at risk than women, and the risk increases with age, particularly after the age of 85.
Prevalence of brain hemorrhage in India
According to a systematic study, the incidence of intracerebral hemorrhage (ICH) in India varied greatly, with estimates ranging from 11% to 35% of all stroke patients, depending on the area. Studies indicated that ICH accounted for 35% of strokes in Kolkata and 11% in Trivandrum.
Males and older people are significantly more likely to experience hemorrhagic strokes. Hypertension (high blood pressure) has been recognized as a significant risk factor for cerebrovascular strokes, contributing considerably to their incidence.
Brain hemorrhage types
Each type of brain hemorrhage has a unique cause, resulting in varying clinical findings, prognosis, and outcomes . Below are the various types of brain hemorrhages:
- Intracerebral /Intraparenchymal hemorrhage
- Subarachnoid hemorrhage (SAH)
- Subdural hemorrhage
- Epidural hemorrhage
Intracerebral /Intraparenchymal hemorrhage: Intraparenchymal hemorrhage is defined as bleeding into the brain's parenchymal tissue. Hemorrhage can occur for a several reasons, including hypertension, arteriovenous malformation (AVM), amyloid angiopathy, tumor, aneurysm rupture, coagulopathy, vasculitis, infection, and trauma.
Subarachnoid hemorrhage (SAH): A subarachnoid hemorrhage is defined as bleeding into the subarachnoid space (area between the arachnoid mater and pia mater). There are two types of subarachnoid hemorrhage: traumatic and non-traumatic. A second classification distinguishes between aneurysmal and non-aneurysmal subarachnoid hemorrhages. Aneurysmal subarachnoid hemorrhage is caused by the rupture of a cerebral aneurysm. Non-aneurysmal subarachnoid hemorrhage is defined as bleeding into the subarachnoid space in the absence of any recognizable aneurysms.
Subdural hemorrhage: A Subdural hemorrhage occurs when blood enters the subdural space, (between the arachnoid mater and the dura mater). Subdural hemorrhage happens when a vessel that connects the brain and skull is stretched, injured, or torn and starts bleeding into the subdural region.
Epidural hemorrhage: An epidural hemorrhage is defined as bleeding into the area between the dura mater (outer protective layer of the brain) and the skull. An epidural hemorrhage is either arterial or venous in origin. The classic arterial epidural hematoma develops following physical trauma to the head, usually in the temporal area. This type of bleeding can also occur following a penetrating head injury.
Brain hemorrhage symptoms
Brain hemorrhage, or bleeding in the brain, can cause a several symptoms, which may vary in severity depending on the location and extent of the bleeding. Here are some common symptoms related to brain hemorrhages:
- Sudden headache: This is a characteristic symptom, particularly in conditions of a subarachnoid hemorrhage, and is sometimes regarded as the worst headache ever.
- Weakness or numbness: Patients may develop weakness or numbness, usually affecting one side of the body, indicating possible stroke-like complications.
- Nausea and vomiting: These symptoms usually accompany severe headaches caused by high intracranial pressure.
- Altered consciousness: This ranges from confusion to loss of consciousness.
- Neck pain or stiff neck: This could signify irritation of the meninges that surround the brain.
- Confusion and trouble concentrating: Cognitive problems may cause confusion or difficulties focusing.
- Drooping eyelid: This may occur because of nerve involvement.
- Difficulty speaking: Speech can become slurred or difficult for people to understand.
- Seizures: Irritation of brain tissue can cause new-onset seizures.
- Vision changes: Symptoms may include impaired or double vision, as well as sensitivity to light.
Brain hemorrhage causes
Understanding the brain hemorrhage reasons is important for prevention and appropriate treatment. The following are the primary causes of brain hemorrhage:
- Head trauma: Traumatic injuries are the major cause of brain hemorrhages, especially among people under 50. Falls, vehicle accidents, and sports-related incidents can all cause such injuries.
- Aneurysms: Aneurysms are weak areas in blood vessel walls that can bulge and rupture, resulting in extensive brain bleeding. They are a frequent cause of subarachnoid hemorrhage (SAH).
- Hypertension (High Blood Pressure): Chronic hypertension is the most prevalent cause of spontaneous intracerebral hemorrhage. It gradually weakens the blood vessel walls, causing them to rupture. Lipohyalinosis and Charcot-Bouchard microaneurysms are both associated with hypertension-related bleeding.
- Blood disorders: Haemophilia and thrombocytopenia are conditions can impair blood clotting ability, increasing the risk of a brain hemorrhage. Patients taking anticoagulant treatment have increased risks.
- Cerebral amyloid angiopathy (CAA): CAA is the deposition of amyloid proteins in blood vessel walls, particularly in older individuals , which increases the risk of lobar hemorrhages. This disorder is commonly related to aging and hypertension.
- Brain tumors: Tumours can damage the normal blood vessel structure, resulting in bleeding within or near the tumor site.
- Blood vessel abnormalities: Arteriovenous malformations (AVMs) are congenital conditions that can cause weak blood vessels to rupture and bleed. Such anomalies can be asymptomatic until they cause serious issues.
- Alcohol and substance abuse: Alcohol and cocaine usage can cause acute elevations in blood pressure and possibly hemorrhagic episodes.
- Pregnancy related complications: Conditions such as eclampsia can cause severe hypertension during pregnancy, leading to intracranial hemorrhage.
Brain hemorrhage risk factors
The risk factors of brain hemorrhage can be categorized into modifiable and non-modifiable. It includes the following:
- Modifiable risk factors
- Non-modifiable risk factors
Modifiable risk factors
Individuals can minimize their risk of brain hemorrhage by changing or managing the following factors:
- Hypertension: Chronic hypertension (high blood pressure) is the most major significant risk factor.
- Alcohol consumption: This risk appears to be dose-dependent, with people who consume more alcohol daily having a higher risk of intracerebral hemorrhage (ICH). This risk may be attributed to acute changes in blood pressure after consumption and withdrawal, effects on platelet function and coagulation, and vascular endothelial dysfunction.
- Smoking: Tobacco use raises the risk of developing cerebrovascular diseases.
- Obesity: Obesity can cause hypertension and other health problems, increasing the risk of hemorrhage.
- Diabetes management: Diabetes that is not well controlled can lead to vascular problems.
- Physical inactivity: A sedentary (inactive) lifestyle can lead to obesity and hypertension.
- Anticoagulant medications: The use of anticoagulants (blood thinners) can increase the risk of a brain hemorrhage.
Non-modifiable risk factors
These includes the factors that cannot be modified.
- Genetic predispositions: Certain hereditary conditions, such as arteriovenous malformations (AVMs), can increase the risk.
- Age: The risk of brain hemorrhage increases with age, especially among people over the age of 55.
- Family history: Individuals with a family history of cerebrovascular disease may be at an increased risk.
Brain hemorrhage complications
A brain hemorrhage can cause several significant problems that affect patient outcomes and the quality of life. Here are the main complications related to brain hemorrhage:
- Neurological deficits: Depending on the part of the brain affected, patients may experience weakness, numbness, trouble speaking, or coordination and balance issues.
- Brain herniation: When pressure within the skull (intracranial pressure) increases, the brain is forced laterally and downward through small openings in the relatively hard sheets of tissue that separate the brain into compartments. It is known as a cerebral herniation, which is a medical emergency.
- Vasospasm: Vasospasm (also known as delayed cerebral ischemia) occurs when a blood vessel contracts and narrows. As a result, the blood flow to the brain becomes dangerously low, interfering with normal brain activities and causing damage. It is most common a few days following the first bleeding.
- Seizures: Haemorrhages can irritate brain tissue, resulting in seizures that may occur immediately or later.
- Increased intracranial pressure (ICP): Blood accumulation can cause swelling and increased pressure within the skull, causing brain tissue to damaged and impaired neurological function to be.
- Rebleeds: A potentially fatal early consequence of a subarachnoid hemorrhage is the brain aneurysm rupture after it has been repaired. This process is known as rebleeding.
- Death: Brain hemorrhage can be fatal in severe cases, especially if not treated immediately.
Brain hemorrhage diagnosis
The diagnosis of brain hemorrhage follows a systematic approach that involves clinical examination as well as neuroimaging. Below are the steps involved in the diagnosis of brain hemorrhage:
- Initial evaluation
- Symptom evaluation
- Vital signs
- Neurological examination
- Glasgow Coma Scale (GCS) Score
- Laboratory Studies
- Complete blood count (CBC)
- Coagulation studies
- Basic metabolic panel
- Imaging tests
- Non-contrast computed tomography (CT) scan
- CT angiography (CTA)
- Magnetic resonance angiography (MRA)
- Lumbar puncture
Brain hemorrhage treatment
Immediate neurosurgical consultation is indicated for all hemorrhages, particularly if there are worrying signs such as airway impairment, respiratory failure, or hemodynamic instability. The treatment options for a brain hemorrhage differ based on the type, location, severity, and overall health of the patient. The available treatment options for a brain hemorrhage include the following:
- Initial management
- Stabilization
- Medical management
- Blood pressure control
- Coagulation correction
- Surgical management
- Burr hole evacuation
- Craniotomy
- External ventricular drain (EVD)
- Clipping or repairing aneurysms
- Minimally invasive techniques
- Post-acute care
- Antiepileptic medications
- Rehabilitation services
Brain hemorrhage prevention
Addressing various risk factors and maintaining healthy lifestyle choices are key to preventing brain hemorrhage. Below are some essential preventive measures involved in preventing brain hemorrhage:
- Controlling high blood pressure: High blood pressure is the most important risk factor for brain hemorrhage. Regular monitoring and treatment of blood pressure, ideally maintaining it below 120/80 mm Hg, can greatly lower the risk of hemorrhagic episodes.
- Maintaining a balanced diet: A diet high in whole grains, vegetables, fruits and lean proteins can benefit vascular health. Limiting sodium, sugar, and unhealthy oils is also important. Consuming heart-healthy meals can help reduce the risks associated with high blood pressure.
- Exercising regularly: Regular physical activity (at least four hours per week) has been linked to lower hemorrhage volumes in patients with intracerebral hemorrhage. Exercise can help prevent serious brain hemorrhage by improving overall cardiovascular health in the individuals .
- Limiting alcohol consumption: Alcohol consumption needs to be reduced; excessive intake might raise blood pressure and increase the risk of bleeding.
- Smoking cessation: Quitting smoking is essential since it raises the risk of vascular damage and clot formation.
- Preventing head injuries: Wearing seat belts while driving and helmets when riding or participating in contact sports can considerably decrease the risk of head trauma, which is a common cause of brain bleeding.
- Regular health checkups: To avoid bleeding complications, patients using anticoagulants need to adhere to medical advice and monitor coagulation parameters strictly.
Difference between CT brain infarct and Hemorrhage
CT brain infarct vs hemorrhage
The below table summarises the main distinctions between brain infarctions and hemorrhages as observed on CT imaging, indicating their distinct characteristics and clinical importance.
| Parameter | Brain infarct | Brain hemorrhage |
|---|---|---|
| Definition | A brain infarction, also known as an ischaemic stroke, develops when blood flow to a specific area of the brain is interrupted, resulting in tissue death due to a lack of oxygen. | A brain hemorrhage is defined as bleeding that occur in or around the brain, that can be caused by trauma, hypertension, or vascular abnormalities. |
| CT appearance | The damaged region appears as a hypodense (dark) area, indicating brain tissue loss. | The presence of blood causes the area to appear hyperdense (bright). |
| Surrounding edema | Edema may be present, but it is typically less severe than a hemorrhage. | Significant edema usually surrounds the hemorrhage, indicating high intracranial pressure. |
| Vascular signs | May exhibit signs of vascular occlusion (e.g., hyperdense vessel sign). | Typically lacks particular vascular symptoms; nevertheless, if large, it may exhibit a mass effect. |
| Diagnosis confirmation | MRI may be more sensitive for early detection, whereas CT is usually utilized for initial evaluation. | CT is the gold standard for identifying and recognizing acute hemorrhage due to its quickness and accessibility. |
Frequently Asked Questions (FAQs) on Brain Hemorrhage
Can stress cause brain hemorrhage?
A subarachnoid hemorrhage is any bleed that occurs beneath one of the brain's protective layers, called the arachnoid layer. High blood pressure, physical exercise, and mental stress can all raise the risk of aneurysm or AVM rupture.
Are brain hemorrhages hereditary?
Brain hemorrhages can be hereditary, especially when genetic abnormalities impact blood vessel integrity, such as arteriovenous malformations (AVMs) or certain connective tissue disorder. A family history of cerebrovascular disease may potentially raise the risk of hemorrhage.
Can a brain hemorrhage happen again?
Yes, a brain hemorrhage can happen again, especially if the underlying risk factors, such as hypertension or vascular abnormalities, are not adequately controlled. Individuals who have had a hemorrhage may be at a higher risk for additional events due to structural defects in blood vessels. Continuous monitoring and control of risk factors are required to lower the possibility of a recurrence.
Can brain hemorrhage be cured?
A brain hemorrhage can often be adequately treated, but whether it can be "cured" is determined by several criteria, including the cause, location, and severity of the hemorrhage. The treatment plan may include medical management, pressure relief surgery, or addressing underlying causes. While many people can totally cure or greatly improve, some may have long-term consequences depending on the severity of the damage.
Can coughing cause brain hemorrhage?
There are normally no warning indications, however, a subarachnoid hemorrhage can occur during physical activity or straining, such as coughing, going to the toilet, lifting something heavy, or having sex.
Can migraine cause brain hemorrhage?
Intracerebral hemorrhage caused by migraine is extremely rare, with only a few cases recorded in the literature. A critical assessment of these cases indicates that migraines were excluded as a cause of intracerebral hemorrhage.
Is it safe to drive after a brain hemorrhage?
Driving after a brain hemorrhage is generally not advised unless a complete medical examination certifies that it is safe to do so. Cognitive function, physical abilities, and the risk of seizure need to be evaluated. Individuals are usually advised to wait at least 6 to 12 months after an injury before considering a return to driving, depending on their recovery progress and medical recommendations.
What causes brain hemorrhage during pregnancy?
Multiple factors can lead to brain hemorrhage during pregnancy, such as hypertension, preeclampsia, and trauma. In addition, vascular abnormalities such as arteriovenous malformations (AVMs) can cause brain bleeding. Pregnancy-related physiological changes can worsen these problems, increasing the risk of hemorrhage.
What is petechial hemorrhage in the brain?
Petechial hemorrhage in the brain is characterized by minute, pinpoint-sized pockets of bleeding inside the brain tissue or surrounding membranes. These microhemorrhages can be caused by a variety of factors, including trauma, hypertension, or infections, and may signal underlying vascular problems. Depending on their location and severity, petechial hemorrhages might cause neurological symptoms.
Can a person turn to normal after a brain bleed?
Some people may feel better in a few weeks or months, while others may not recover completely, even after many years. This will be determined in large part by the severity of the brain injury.
Is brain hemorrhage a cause of sudden death?
Cardiovascular illness, particularly hemorrhage, is the most common cause of sudden death. The most prevalent type of life-threatening hemorrhage is that develops in the brain as a result of vascular disease.
What to avoid after a brain bleed?
People need to avoid strenuous physical activities such as heavy housework, weightlifting/working out, and those that require a lot of concentration. These can all aggravate the symptoms and delay the recovery process from a brain bleed.
Can a brain bleed cause hearing loss?
Sudden deafness as the first symptom of intracerebral hemorrhage, particularly supratentorial hemorrhage, is uncommon. Because the auditory nerve is innervated on both sides, bilateral intracerebral hemorrhage is typically the cause of cortical hearing loss.
Can a brain bleed be stopped without surgery?
Non-surgical treatments include administering clotting factors if the patient is taking blood thinners, controlling blood pressure to minimize the risk of further bleeding, and measuring and controlling intracranial pressure (ICP) (pressure on brain tissue caused by a clot).
Request an appointment
Fill in the appointment form or call us instantly to book a confirmed appointment with our super specialist at 04048486868
Appointment request - health articles
Our Locations
Metro Pillar Number C1772, Beside Avasa Hotel, Hitech City Road, Near HITEC City Metro Station, Hyderabad, Telangana, India.
Mythri Nagar, Beside South India Shopping Mall, Hafeezpet, Madeenaguda, Hyderabad, Telangana, India.
040 4848 6868
Payment in advance for treatment at PACE Hospitals, Hyderabad, Telangana, India (Pay in INR ₹)
For Bank Transfer:-
- Bank Name: HDFC
Company Name: Pace Hospitals
A/c No.50200028705218
IFSC Code: HDFC0000545 - Bank Name: STATE BANK OF INDIA
Company Name: Pace Hospitals
A/c No.62206858997
IFSC Code: SBIN0020299
Scan QR Code by Any Payment App (GPay, Paytm, Phonepe, BHIM, Bank Apps, Amazon, Airtel, Truecaller, Idea, Whatsapp etc).
CONTACT US
Call: +914048486868
WhatsApp: +918977889778
Email: info@pacehospitals.in
FOLLOW US
SUBSCRIBE
Subscribe to our newsletter and stay updated with the latest health information.
ABOUT US
QUICK LINKS
SPECIALITIES
Disclaimer
General information on healthcare issues is made available by PACE Hospitals through this website (www.pacehospital.com), as well as its other websites and branded social media pages. The text, videos, illustrations, photographs, quoted information, and other materials found on these websites (here by collectively referred to as "Content") are offered for informational purposes only and is neither exhaustive nor complete. Prior to forming a decision in regard to your health, consult your doctor or any another healthcare professional. PACE Hospitals does not have an obligation to update or modify the "Content" or to explain or resolve any inconsistencies therein.
The "Content" from the website of PACE Hospitals or from its branded social media pages might include any adult explicit "Content" which is deemed exclusively medical or health-related and not otherwise. Publishing material or making references to specific sources, such as to any particular therapies, goods, drugs, practises, doctors, nurses, other healthcare professionals, diagnoses or procedures is done purely for informational purposes and does not reflect any endorsement by PACE Hospitals as such.
