Brain haemorrhages are bleeds into the brain tissue or between the membranes surrounding the brain. They are emergencies that can present with sudden headache, paralysis or loss of consciousness.
What is a brain haemorrhage?
A brain haemorrhage is the leakage of blood into an area inside the skull where it should not normally be. It is named according to where the bleeding occurs:
- Intracerebral haemorrhage: Bleeding into the brain tissue itself. The most common cause is long-standing high blood pressure.
- Subarachnoid haemorrhage: Bleeding into the space between the membranes surrounding the brain. Apart from trauma, the most common cause is a ruptured aneurysm.
- Subdural haematoma: Blood collecting between the brain membranes and the brain, usually after head injury; in older people it can develop over weeks after minor knocks (chronic subdural haematoma).
- Epidural haematoma: Bleeding between the skull and the outermost membrane, usually caused by trauma.
Main causes
- High blood pressure
- Vascular conditions such as aneurysms and arteriovenous malformations
- Head injury
- Use of blood-thinning medication or clotting disorders
- Some brain tumors
Symptoms
The following symptoms are an emergency — call emergency services:
- Sudden severe headache
- Nausea and vomiting
- Weakness or numbness on one side of the body
- Speech disturbance, loss of vision
- Confusion, drowsiness, seizures or loss of consciousness
Symptoms of chronic subdural haematoma can be more subtle: headache increasing over weeks, forgetfulness, imbalance and weakness on one side.
Diagnosis
In an emergency, brain CT is the first investigation and quickly shows the location and size of the bleed. CT angiography, MRI or digital subtraction angiography may be performed to find the underlying cause.
Treatment Approach
Treatment depends on the type, size and location of the bleed and the patient's condition:
- Intensive care: Blood pressure control, monitoring of intracranial pressure, correction of clotting disorders and prevention of seizures.
- Surgery: Evacuation of large haematomas causing compression, procedures to lower intracranial pressure, or drainage when the flow of cerebrospinal fluid is blocked. Chronic subdural haematomas can usually be drained through a small burr hole.
- Treatment of the underlying cause: If a cause such as an aneurysm or AVM is found, treatment is given to prevent re-bleeding.
- Rehabilitation: Physiotherapy, speech and occupational therapy for deficits after the bleed are an important part of recovery.