Brain Hemorrhage - Causes, Symptoms, Diagnosis, Prevention & Treatment
Health Education

Brain Hemorrhage: Causes, Symptoms and Treatment

Dr.A K Purohit profile Authored by Dr.A K Purohit on 22 Dec 2014 - 11:56.

A localized bleeding inside the cranium caused due to the bursting of the blood vessels is referred as brain hemorrhage. Brain hemorrhages are also called intracranial hemorrhages, cerebral hemorrhages or, intra-cerebral hemorrhages which constitute to about 13 percent of strokes.

A bleeding can occur within the brain, between membranes that cover it and the brain, or the covering of the brain between and the skull. With bleeding, the pooled blood inside the skull can cause irritation leading to the swelling of the brain cells. A mass is formed by this pooled blood which is called as hematoma. This causes increase in the intra-cranial pressure leading to reduction in the blood flow to the brain cells. The brain cells then get killed due to lack of blood supply causing a hemorrhage.

Depending on the site of bleeding brain hemorrhages can be broadly classified as follows:

  • Intra-cerebral hemorrhage: The bleeding occurs inside the brain itself.
  • Subarachnoid hemorrhage: The bleeding occurs between the brain tissue and the covering of the brain.
  • Epidural or subdural hematoma: A blood clot is formed between the brain and the skull.

Brain hemorrhages can be caused by the following factors:

  • High blood pressure: High blood pressure weakens the walls of blood vessels when it is not under control for long duration.
  • Head trauma: Head injury is a common cause of brain hemorrhages in younger people.
  • Aneurysm: Weakening of the walls of blood vessels is called aneurysm. This can eventually burst and cause bleeding.
  • Amyloid angiopathy: Abnormality of the walls of blood vessels due to high blood pressure or ageing can cause minute bleedings which can later turn into larger bleedings.
  • Blood vessel abnormalities: Some people may have malformations in the blood vessels supplying blood to the brain from birth. These abnormalities are usually identified only after the appearance of symptoms.
  • Blood disorders: Disorders such as sickle cell anemia and hemophilia causes a decrease in platelet count thereby increasing the risk of bleeding.
  • Liver diseases
  • Brain tumors

Depending on the site and severity of bleeding, the symptoms may vary. The onset of symptoms may be sudden or delayed. The symptoms include:

  • Nausea or vomiting
  • A sudden and severe headache
  • Seizures
  • Changes in vision
  • Weakness in an arm or leg
  • Difficulty in swallowing
  • Decreased alertness
  • Lethargy
  • Tingling or numbness
  • Difficulty in speaking, writing, reading or understanding speech
  • Loss of fine motor skills, such as hand tremors
  • Loss of balance
  • Loss of coordination
  • Loss of consciousness
  • An abnormal sense of taste

When a brain hemorrhage is suspected, the physical evaluation for the symptoms such as slurred speech, weakness and loss of sensations is done. To further confirm it, the following tests are required to be done.

  • Computerized tomography (CT scan): This test is done to study the images of brain and to confirm bleeding or skull fractures.
  • Magnetic resonance imaging (MRI): This test is done to identify the cause of hemorrhage and also to study the brain more accurately.
  • Angiogram: This test helps to study the blood flow inside the arteries.
  • Blood tests: These tests may also be carried out to detect disorders in immune system, inflammation or blood clotting.

Risk factors for brain hemorrhages include:

  • Alcohol abuse
  • Cigarette smoking
  • Genetic factors
  • Hypertension
  • Use of drugs such as amphetamines
  • Extreme physical exertion

Patients with brain hemorrhage must be monitored very strictly and should be treated as early as possible. Early treatment involves the monitoring of breathing and blood pressure. Sometimes specialized monitoring of blood oxygen levels, heart rhythms and intra-cranial pressure is required. Ventilator may be required to maintain the levels of oxygen in the brain and body. If the patient is unconscious the fluids and medications should be given intra-venously.

Once the patient is stable, the decision of how to control the bleeding has to be made based on the site and size of the hemorrhage. It may be treated either by medications or surgical procedures. All intra-cranial hemorrhages do not require a surgical intervention.

The following class of drugs may be prescribed for treating brain hemorrhages:

  • Anti-anxiety drugs: These are prescribed to control the blood pressure of the patient and to eliminate the risk of seizures.
  • Antiepileptic drugs: These are prescribed if the patient is suffering from convulsions.
  • Analgesics: Pain killers may be prescribed if the patient is having severe headache.

Surgical interventions:

Surgery may be required if the bleeding cannot be stopped by medications. It is usually done to reduce the intra-cranial pressure or to repair the damaged blood vessels in the skull.

Adjuvant therapies:

Long term adjuvant therapies may be required to overcome the symptoms of brain damage.These may include physical or verbal therapy to improve the muscle function and communication respectively.

What research is being done on Cerebral Aneurysm?

The National Institute of Neurological Disorders and Stroke (NINDS), is conducting research on intracranial aneurysms and other vascular lesions of the nervous system. A cerebral aneurysm (also known as an intracranial or intracerebral aneurysm) is a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood. The bulging aneurysm can put pressure on a nerve or surrounding brain tissue. It may also leak or rupture, spilling blood into the surrounding tissue (called a hemorrhage)

The NINDS sponsored the International Study of Unruptured Intracranial Aneurysms, which included more than 4,000 people at 61 sites in the United States, Canada, and Europe.

Findings: The findings suggest that the risk of rupture for most very small aneurysms (less than 7 millimeters in size) is small. The results offer guidance to individuals and physicians facing the difficult decision about whether or not to treat an aneurysm surgically. Though the relationship between intracranial and aortic aneurysm was recognized much earlier, it was not well quantified.

Recent genome-wide association studies (GWAS) provide molecular evidence for shared biological function and activities (pathophysiology) of these aneurysms. 

Aspirin may lessen inflammation in cerebral aneurysms and reduce their incidence of rupture. Scientists using enhanced MRI to monitor the signal generated by macrophages  (a type of white blood cell that travels to the injury site during the inflammatory response) hope to determine if taking aspirin daily for three months will reduce the MRI signal changes generated by macrophages in the aneurysm wall.

The incidence of intracranial aneurysms is more common in women (after menopause) than in men. Estrogen replacement therapy reduces the risk for subarachnoid hemorrhage in post-menopausal women. Researchers are investigating the role of estrogen in the pathophysiology of intracranial aneurysms.

 

Reference:http://www.ninds.nih.gov/disorders/cerebral_aneurysm/detail_cerebral_aneurysms.htm#3098_1

 

The prevention steps for brain hemorrhages include:

  • Smoking cessation
  • Treating heart disease
  • Treating hypertension
  • Keeping blood glucose levels under control
  • Maintaining a healthy lifestyle

References:

  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291314/
  • http://www.healthgrades.com/conditions/cerebral-hemorrhage
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.