A brain hemorrhage is actually a bleeding in or around the brain. Causes of brain hemorrhage are inclusive of high blood pressure, abnormally weak blood vessels that leak, drug abuse, and trauma. Many people who experience a brain hemorrhage have signs and symptoms as though they are having a stroke, and can develop weakness on one side of their body, difficulty speaking, or a sense of numbness. Difficulty carrying out usual activities, including problems with walking or even falling, are not uncommon signs and symptoms. About 10% of all strokes are hemorrhagic, or created by bleeding into the brain.
Brain hemorrhage is often tagged according to precisely where it happens in the brain. In general, bleeding anywhere inside of the skull is known as an intracranial hemorrhage. Bleeding within the brain itself is called intracerebral hemorrhage. Bleeding can also happen between the covering of the brain and the brain tissue itself, referred to as a subarachnoid hemorrhage. If a blood clot happens between the skull and the brain, it is known as either a subdural or epidural hematoma depending on whether it is below or above the tough covering (dura) of the brain. Subdural and epidural hematomas are more likely to happen as a result of trauma or after a fall and will not be addressed in detail here.
It is vital to recognize that when bleeding happens within the brain itself, headache may not happen, as our brains don’t have the ability to sense the ongoing disturbance. However, the coverings of the brain (meninges) are extremely sensitive and if bleeding happens there, as when an aneurysm ruptures, a sudden and severe headache is a common sign.
What causes a brain hemorrhage?
The most common cause of a brain hemorrhage is an elevated blood pressure. Over time, elevated blood pressure can weaken arterial walls and result in rupture. When this happens, blood collects in the brain leading to symptoms of a stroke. Other causes of hemorrhage include aneurysm — a weak spot in the wall of an artery — which then balloons out and may break open. Arteriovenous malformations (AVM) are abnormal connections between arteries and veins and are usually present from birth and can cause brain hemorrhage later in life. In some situations, people with cancer who develop distant spread of their original cancer to their brain (metastatic disease) can develop brain hemorrhages in the areas of brain where the cancer has spread. In elderly individuals, amyloid protein deposits along the blood vessels can make the vessel wall to weaken resulting in a hemorrhagic stroke. Cocaine or drug abuse can weaken blood vessels and result in bleeding in the brain. Some prescription drugs can also heighten the risk of brain hemorrhage.
What are the symptoms of a brain hemorrhage?
Although headache is frequently linked with bleeding in the brain, it is not always present. Most often, the symptoms linked with a brain hemorrhage are dependent on the particular area of the brain that is involved. If the bleeding is in the area of the brain associated with vision, there may be problems seeing. Problems with balance and coordination, weakness on one side, numbness, or sudden seizure may occur. The speech center for many people is found in the left side of the brain and bleeding into this area may cause marked speech disturbances. If the bleeding is in the lower brain (brainstem), where most of the automatic body functions are regulated, a patient may get unresponsive or go into a coma . Additionally, sometimes symptoms of brain hemorrhage may come on very abruptly and rapidly worsen. Alternatively, the signs may progress slowly over many hours or even days.
How is a brain hemorrhage diagnosed?
If any kind of stroke is suspected, immediate evaluation is required. Examination may show evidence of brain injury with weakness, slurred speech, and/or loss of sensations. Generally, a radiology examination is needed, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. The CT or MRI can highlight various features and location of brain bleeding. If bleeding inside of or around the brain is observed, further testing may be ordered to try to know the cause of the bleeding. This additional testing can assist to determine if abnormal blood vessels are present as well as the next step in either diagnosis or treatment. In certain cases, a spinal tap (lumbar puncture) may be needed to confirm evidence of bleeding or rule out other brain problems.
What is the treatment for a brain hemorrhage?
Patients with bleeding inside of the brain must be monitored very closely. Early treatment includes stabilizing blood pressure and breathing. A breathing assist machine (ventilator) can be needed to ensure that enough oxygen is sent to the brain and other organs. Intravenous access is required so that fluids and medications can be given to the patient, especially if the person is unconscious. Sometimes specialized monitoring of heart rhythms, blood oxygen levels, or pressure inside of the skull is required.
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After a person has been stabilized, then a determination of how to address the bleeding is made. This stabilization and decision-making process happens very rapidly. The decision to carry out surgery is based on the size and location of the hemorrhage. Not everyone with an intracranial hemorrhage needs to have surgery.
Various medications may be used to assist decrease swelling around the area of the hemorrhage, to keep blood pressure at an optimal level, and to guard seizure. If a patient is awake, pain medication may be required.