What is a Brain Hemorrhage?

A brain hemorrhage is bleeding in or around the brain. It may also be called an intracranial hemorrhage, intracerebral hemorrhage, hemorrhagic stroke, brain bleed, or intracranial hematoma, depending on where the bleeding occurs.

Brain hemorrhage can happen within the brain tissue, around the brain, or inside the brain’s fluid spaces. Types may include intracerebral hemorrhage, subarachnoid hemorrhage, subdural hematoma, epidural hematoma, and intraventricular hemorrhage. Some brain hemorrhages are related to stroke, while others are related to head trauma, aneurysm rupture, vascular malformation, blood-thinning medication, or other medical conditions.

Brain hemorrhage can increase pressure inside the skull, irritate brain tissue, block normal cerebrospinal fluid flow, or affect areas that control speech, movement, vision, balance, memory, and consciousness. De Novo Brain & Spine evaluates adult patients with brain hemorrhage-related neurosurgical concerns, including hematoma, hydrocephalus, mass effect, aneurysm, vascular malformation, or surgical treatment planning after emergency evaluation.

Common Signs and Symptoms

Brain hemorrhage symptoms can begin suddenly and may worsen quickly. Symptoms depend on the location, size, cause, and speed of bleeding.

Common signs and symptoms may include:

• Sudden severe headache
• Headache with nausea or vomiting
• Weakness, numbness, or tingling in the face, arm, or leg
• Facial drooping
• Trouble speaking, slurred speech, or difficulty understanding speech
• Vision changes, including blurred vision, double vision, or vision loss
• Balance problems, dizziness, or trouble walking
• New-onset seizure
• Confusion, agitation, or change in behavior
• Drowsiness, decreased alertness, fainting, or loss of consciousness
• Neck stiffness or sensitivity to light, especially with subarachnoid hemorrhage
• Worsening neurological symptoms after a head injury
• Severe sleepiness, repeated vomiting, or unequal pupils in some cases

Seek emergency medical care or call 911 for sudden severe headache, first-time seizure, sudden weakness, sudden speech difficulty, sudden vision loss, repeated vomiting, severe confusion, loss of consciousness, or rapid neurological decline.

What Causes This Condition?

A brain hemorrhage occurs when blood leaks from a blood vessel in or around the brain. The cause depends on the type and location of bleeding.

Possible causes and risk factors may include:

• High blood pressure, also called hypertension
• Head trauma, including falls, motor vehicle accidents, or other injuries
• Ruptured brain aneurysm, which may cause subarachnoid hemorrhage
• Cavernous malformation, dural AV fistula, arteriovenous malformation, or other vascular malformation
• Blood-thinning medication, also called anticoagulant or antiplatelet therapy, in some patients
• Bleeding disorders or problems with blood clotting
• Cerebral amyloid angiopathy, a blood vessel condition more common in older adults
• Brain tumor-related bleeding in selected cases
• Liver disease, low platelet count, or other medical conditions that affect clotting
• Prior stroke, vascular disease, or certain blood vessel abnormalities

These are causes or risk factors, not guarantees that bleeding will occur. Treatment planning depends on the hemorrhage type, location, size, cause, imaging findings, neurological condition, medication history, and overall health.

How It Is Diagnosed?

Brain hemorrhage is usually diagnosed through emergency medical evaluation, neurological examination, and brain imaging. Because symptoms can be serious or rapidly progressive, suspected brain hemorrhage should be evaluated urgently.

Common diagnostic steps may include:

• Emergency medical assessment to determine symptom timing, injury history, medication use, blood pressure, and neurological status
• Neurological examination to evaluate alertness, speech, vision, eye movement, facial movement, strength, sensation, coordination, balance, and reflexes
• CT scan of the head, often the first imaging test used to detect acute bleeding
• MRI of the brain to evaluate brain tissue, older bleeding, small hemorrhages, tumors, vascular malformations, or other related findings
• CT angiography, also called CTA, to evaluate blood vessels and look for aneurysm, vascular malformation, or active bleeding risk
• MR angiography, also called MRA, when additional blood vessel imaging is needed
• Digital subtraction angiography, also called catheter angiography or cerebral angiography, in selected cases when detailed vascular imaging is needed
• Blood tests to check blood count, platelet level, clotting function, kidney function, blood sugar, and medication-related bleeding risk
• Repeat CT or MRI imaging when monitoring hemorrhage size, swelling, hydrocephalus, or clinical changes
• Evaluation for hydrocephalus or increased intracranial pressure when blood blocks cerebrospinal fluid flow or causes pressure in the brain

The goal of diagnosis is to confirm bleeding, identify the hemorrhage type and cause, determine whether pressure or hydrocephalus is present, and guide urgent medical or neurosurgical treatment.

Treatment Options

Brain hemorrhage treatment depends on the type of bleeding, size and location of the hemorrhage, cause, symptoms, neurological examination, medication history, blood pressure, imaging findings, and overall health. Brain hemorrhage can be a medical emergency and may require care in an emergency department, stroke unit, neurocritical care unit, or hospital setting.

Treatment options may include:

• Emergency neurological care with rapid imaging, monitoring, and stabilization
• Blood pressure management when high blood pressure may worsen bleeding or swelling
• Reversal of blood-thinning medication when appropriate and medically indicated
• Medication for swelling, seizures, pain, nausea, or other symptoms when clinically appropriate
• Intracranial pressure monitoring in selected cases when pressure inside the skull is a concern
• External ventricular drain, also called an EVD, when bleeding causes hydrocephalus or blocks cerebrospinal fluid flow
• Hematoma evacuation when removing a blood clot may help relieve pressure or treat selected hemorrhages
• Craniotomy for hematoma evacuation in selected cases when an open surgical approach is appropriate
• Minimally invasive hematoma evacuation in selected patients when the hemorrhage type, size, location, and clinical status support that approach
• Decompressive craniectomy in selected cases involving severe swelling or pressure
• Treatment of the underlying cause, such as aneurysm repair, vascular malformation treatment, tumor treatment, or management of clotting problems
• Observation with repeat imaging for selected small hemorrhages or stable hematomas that do not require immediate surgery
• Rehabilitation and supportive care to help with strength, speech, swallowing, balance, cognition, vision, or daily function after a hemorrhage

Surgery is not appropriate for every brain hemorrhage. Neurosurgical treatment may be considered when bleeding causes pressure on the brain, hydrocephalus, neurological decline, diagnostic uncertainty, or a treatable structural cause such as aneurysm, vascular malformation, tumor, or selected traumatic hematoma.