What You Need to Know About Cerebral Hemorrhage (Brain Bleed)
This article will further distinguish between bleeding in the brain versus bleeding within the skull. It will also describe possible causes of cerebral hemorrhage, factors that increase the chance of cerebral hemorrhage, diagnosis, treatment, and outlook.
Cerebral hemorrhage is a type of bleeding that can occur inside the skull. Bleeding can occur outside of the brain tissue or within the brain tissue. Here is a brief summary of bleeding outside versus inside the brain:
Bleeding within the skull but outside brain tissue
A common way to describe bleeding within the skull but outside the brain tissue is “bleeding on the brain.” The medical term is intracranial hemorrhage.
If there is damage to a blood vessel on the surface of the brain, blood can collect and form a hematoma between the brain and the membranes, or meninges, that surround it. The location of the damage determines the medical term for the bleeding:
- Epidural bleeding occurs between the skull and the outer layer of the meninges, the dura mater.
- Subdural bleeding occurs between the dura mater and the next layer, the arachnoid.
- Subarachnoid bleeding occurs between the arachnoid and the layer next to the brain, the pia mater.
Head trauma is a common cause of bleeding within the skull but outside of the brain tissue.
Bleeding inside the brain
Bleeding inside the brain is a type of intracranial hemorrhage where bleeding occurs in the brain tissue itself. The medical term for it is “intraparenchymal hemorrhage.” However, it is also known as intracerebral hemorrhage or simply cerebral hemorrhage.
Cerebral hemorrhage is always an emergency and needs to be treated immediately to save as much brain tissue as possible.
What happens when you have a cerebral hemorrhage?
When a person has a cerebral hemorrhage, it means blood has come out of a damaged blood vessel, or multiple damaged blood vessels, and collected in the brain.
Damage to the brain occurs because the brain tissue is deprived of oxygen, which leads to brain cell death. Additionally, pooling blood puts pressure on the brain, which also causes oxygen deprivation and brain cell death.
What is the most common cause of cerebral hemorrhage?
About 60% of cerebral hemorrhages are linked to high blood pressure. With time, untreated high blood pressure can lead to aneurysms and other changes in blood vessels that increase the risk of bleeding.
What is the survival rate of cerebral hemorrhage?
A large Swedish study showed that, overall, about 66% of people who experienced a cerebral hemorrhage were alive 90 days later. People who take medications that inhibit blood clotting have a less favorable outcome than people not taking them.
Survival dropped to 56.9% for people who had been taking either blood thinners or aspirin. Of people who were not on anticoagulant therapy, 73.7% were alive after 90 days.
Symptoms of cerebral hemorrhage are related to the location of the bleeding in the brain. Bleeding in some locations of the brain can interfere with how certain parts of the body function, such as the ability to move or see.
Cerebral hemorrhage is always an emergency and can be fatal. Seek immediate medical care (call 911) for any combination of the following symptoms:
- sudden difficulty with thinking or comprehension
- sudden garbled or slurred speech or inability to speak, write, or read
- sudden numbness or weakness
- sudden paralysis
- sudden loss of vision or changes in vision
- severe headache
- change in level of consciousness or alertness, such as fainting or unresponsiveness
Cerebral hemorrhage is usually a result of blood vessel damage or weakness. Conditions leading to blood vessel damage or weakness can be present at birth or develop throughout a person’s lifetime.
Some medical conditions can increase the chance of cerebral hemorrhage. Just because you have one of these medical conditions does not mean you will develop a cerebral hemorrhage. A cerebral hemorrhage can happen by chance in people with no known risk factors.
Factors that can make cerebral hemorrhage more likely include:
- older age
- bleeding disorder
- anticoagulant (blood thinners), used to reduce blood clotting in people with an increased chance of blood clots
- daily aspirin use
- cocaine and other stimulant use
- unregulated high blood pressure
- brain aneurysm
- amyloid angiopathy, a condition where protein deposits build up along the walls of arteries
- arteriovenous malformations, which are unusual connections between arteries and veins that can be present at birth
- history of stroke
In an emergency setting, a healthcare professional would perform a CT scan without contrast for an initial diagnosis.
When the patient is stable, the doctor will order a cerebral angiogram. This is a CT scan or MRI with a contrast agent to visualize blood vessels more clearly. With this test, the doctor may identify the source and underlying cause of bleeding, which is vital for treatment.
Determining the patient’s medical history, current medications, and blood test results are also important in diagnosing a potential underlying cause and making treatment decisions. For example, if the patient is on anticoagulant therapy, administering medications to reverse its effects could be an initial treatment.
Cerebral hemorrhage treatment depends on the cause of bleeding, its location in the brain, the amount of blood, and the overall health of the patient. The goal of treatment is to stop the bleed and reduce the size of the resulting pool of blood, or hematoma, which will help reduce pressure on the brain.
There are noninvasive and surgical treatment options. After initial treatment, rehabilitation may be necessary to help recover functions that may have been lost.
Treatment without surgery may include:
- medications to reverse the effect of anticoagulants the patient may be on
- clotting factor administration to stop bleeding in people who lack these factors
- medications to reduce blood pressure
- anticonvulsants to control seizures
- pain medications to increase comfort
Surgical and minimally invasive treatments
Surgery for cerebral hemorrhage includes open surgery on the brain and catheter-based treatments to:
- remove small blood clots located near the surface of the brain
- dissolve blood clots in the brain with a thrombolytic agent, to help relieve pressure
- repair blood vessels, including aneurysm repair and arteriovenous malformation repair
- stop or reduce blood flow to the bleeding area
- monitor and reduce intracranial pressure
After surgery or when bleeding is under control and the patient is stable, the process of recovery begins. Depending on the degree of brain damage, recovery can take many months. Some treatments during the recovery phase depend on the underlying cause.
Treatments can include:
- medications to maintain a moderate blood pressure
- medications (or changes in existing medications) to reduce the chance of another bleeding episode
- dietary counseling to help moderate blood pressure and cholesterol
- occupational and speech therapy to help with eating, swallowing, or talking problems
- physical therapy to help strengthen the body, increase alertness, reduce fatigue, and increase functional ability
You may be able to lower your chance of cerebral hemorrhage by:
- managing your blood pressure
- managing your cholesterol by eating nutritiously and exercising regularly
- quitting smoking if you smoke
- ensuring with your doctor that you take the correct dose of anticoagulant or aspirin, as these medicines increase the chance of bleeding
- taking precautions against head trauma, such as wearing a helmet during activities that could result in injury
The outlook for a person with a cerebral hemorrhage depends on many factors, including the person’s age, the location of the bleed in the brain, the volume of the resulting clot, and whether the person was taking blood thinners or aspirin at the time of the bleeding event.
A large study published in 2021 shows that, overall, about 66% of people lived up to 90 days following a cerebral hemorrhage.
Survival dropped to 56.9% for people who had been taking anticoagulant medications, compared with an approximate 73.7% survival rate for people not taking them.
A review of intracerebral hemorrhage mentions the mortality rate can be as high as 50%, with less than 20% of survivors functioning independently at 6 months, but these values are based on older studies.
Complications of cerebral hemorrhage related to brain damage include:
- difficulty swallowing
- difficulty with memory, thinking, talking, comprehension, writing, or reading
- personality changes
- loss of vision or changes in vision
- permanent loss of sensation
- paralysis or weakness
A cerebral hemorrhage is bleeding inside the brain. Other terms for it include intracerebral hemorrhage, intraparenchymal hemorrhage, and hemorrhagic stroke. Signs and symptoms include nausea, severe headache, and sudden neurological symptoms.
Factors that increase the chance of cerebral hemorrhage include unregulated high blood pressure and other conditions that can weaken or damage blood vessels. Taking medications that reduce the blood’s ability to clot can also increase your risk.
Treatment options include medications and procedures to stop bleeding, remove hematomas and blood clots, and manage symptoms.
The outlook for people who survive a cerebral hemorrhage is not favorable, but rehabilitation can help people recover functional ability and independence.