A brain hemorrhage is a type of stroke. It’s caused by an artery in the brain bursting and causing localized bleeding in the surrounding tissues. This bleeding kills brain cells. The Greek root for blood is hemo. Hemorrhage literally means “blood bursting forth”. Brain hemorrhages are also called cerebral hemorrhages, intracranial hemorrhages or intracerebral hemorrhages. They account for about 13% of strokes. Hemorrhagic stroke occurs when a blood vessel bursts inside the brain. The brain is very sensitive to bleeding and damage can occur very rapidly. Bleeding irritates the brain tissue, causing swelling. Bleeding collects into a mass called a hematoma. Bleeding also increases pressure on the brain and presses it against the skull. Hemorrhagic strokes are grouped according to location of the blood vessel: intracerebral hemorrhage (bleeding in the brain) and subarachnoid hemorrhage (bleeding in the area between the brain and the thin tissues that cover the brain). Stroke patients have just hours to get lifesaving treatment and many lose their chance. Know the signs of brain hemorrhage!
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 under 50) and 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. An aneurysm, a weakening in a blood vessel wall that swells, can also cause a brain bleed. It can burst and bleed into the brain, leading to a stroke. Blood vessel abnormalities are another cause – weaknesses in the blood vessels in and around the brain may be present at birth and diagnosed only if symptoms develop. Amyloid angiopathy can cause bleeding – this is an abnormality of the blood vessel walls that sometimes occurs with aging. It may cause many small, unnoticed bleeds before causing a large one. Blood or bleeding disorders, such as hemophilia and sickle cell anemia, can both contribute to decreased levels of blood platelets, which can cause bleeding due to lack of clotting factors. Finally, liver disease and brain tumors both are associated with increased bleeding in general.
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 may develop suddenly or over time. They may progressively worsen or suddenly appear. 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, seizures with no previous history of seizures, weakness in an arm or leg, nausea or vomiting, decreased alertness; lethargy, changes in vision, tingling or numbness, difficulty speaking or understanding speech, difficulty swallowing, difficulty writing or reading, loss of fine motor skills, such as hand tremors, loss of coordination, loss of balance, an abnormal sense of taste and loss of consciousness.
Because the majority of brain hemorrhages are associated with specific risk factors, you can minimize your risk in the following ways:
- Treat hypertension. 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.
- Don’t smoke.
- Don’t use drugs. Cocaine 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. If you suffer from abnormalities, such as aneurysms, surgery may help to prevent future bleeding.
- Be careful with Coumadin. If you take warfarin (Coumadin), follow up regularly with your doctor to make sure your blood levels are in the correct range. Prevention is extremely important because treatment for hemorrhage-related brain injury often cannot reverse brain damage. Most cases of hemorrhagic stroke are associated with specific risk factors such as the ones mentioned above. Controlling blood pressure and avoiding smoking and cocaine can reduce your risk for brain bleeding.
Hemorrhagic stroke requires prompt medical attention. It can develop quickly into a life-threatening situation. Goals of treatment are to save the person’s life, relieve symptoms, repair the cause of bleeding, prevent complications and to start rehabilitation therapy as soon as possible.
In the hospital, treatment may involve carefully controlling blood pressure, which can be too high or too low, drugs to control brain swelling, medications to relief headaches (but should be used with caution because they may reduce alertness and give the wrong impression that the patient is getting worse) and seizure medications such as phenytoin. The patient will need to rest in bed and avoid activities that may increase the pressure in the head (increased intracranial pressure), such as bending, lying flat, sudden position changes and straining during bowel movement (stool softeners or laxatives may be prescribed). Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent. Sometimes surgery is needed to save the patient’s life or to improve the chances of recovery. The type of surgery depends upon the specific cause of brain bleeding. For example, a hemorrhage due to an aneurysm or AVM (ateriovenous malformation) requires special treatment. For other types of bleeding, removal of the hematoma may occasionally be needed, especially when bleeding occurs in the back of the brain.