Cerebral Hemorrhage Overview
Cerebral hemorrhage is bleeding that occurs within or around the brain tissue. Small arteries bring blood to the brain. If these arteries rupture, blood is released into the brain tissue. The blood forms a clot (hematoma), which can grow and exert pressure on surrounding tissue. As blood enters the brain, the area supplied by the artery is deprived of oxygen-containing blood. This is a stroke. When the bleeding involves a blood vessel in the brain it is known as a hemorrhagic stroke, which is the most deadly type.
The primary cause of cerebral hemorrhage is a diseased or damaged blood vessel in the brain that bursts. This allows blood to leak inside the brain. The sudden increase in pressure can damage brain cells. And a sudden increase in the amount of blood can cause loss of consciousness or even death. Cerebral hemorrhage can occur at all ages, but is more common in adults than in children.
Types of cerebral hemorrhage include:
- Intracerebral hemorrhage—bleeding inside the brain
- Subarachnoid hemorrhage—bleeding between the brain and the membranes that cover the brain
- Epidural hemorrhage—bleeding between the skull and the covering of the brain
- There are several causes of bleeding inside the skull, known generally as intracranial hemorrhage.
- Head injuries
- Arteriovenous Malformation, an abnormality of the arteries or veins in or around the brain
- Aneurysm, a weakening of the blood vessel that can cause a bleed or stroke
- Poorly controlled high blood pressure over time that can weaken blood vessels and lead to bleeding within the skull
- Amyloid angiopathy, a buildup of protein on the walls of the arteries of the brain
Wellstar neurologists and neurosurgeons are expert at diagnosing and treating cerebral hemorrhage.
Symptoms can vary depending on the location and the amount of bleeding. Symptoms, which typically come on suddenly, may include:
- Sudden severe headache with no known cause
- Increasing neurologic problems such as numbness, weakness, inability to move (paralysis) loss of speech or vision and confusion
- Vomiting or severe nausea, when present with other symptoms
- Partial or total loss of consciousness
Call 911 if you see or experience any of these symptoms. Treatment can be more effective if it is delivered quickly.
Risk factors for cerebral hemorrhage include the following:
- High blood pressure (hypertension). If your blood pressure is consistently higher than 135/85 talk with your WellStar physician about treatment options
- Excessive use of drugs and alcohol
- Use of blood anti-clotting medication can cause the blood to become too thin, which puts you at risk for cerebral hemorrhage
- Blood clotting disorders such as hemophilia or sickle cell anemia
- Cigarette smoking
Cerebral Hemorrhage Prevention
Treating the underlying disorder can help prevent cerebral hemorrhage. Treat high blood pressure with help from your Wellstar physician.
- Limit salt intake and eat a diet rich in fruits and vegetables.
- Control your weight with diet and exercise, as excess weight can contribute to high blood pressure.
- Seek treatment for conditions like aneurysm and arterious malformation before they cause bleeding in the brain.
- Stop smoking or don’t start. Wellstar offers excellent smoking cessation programs and resources.
- Do not use illegal drugs or excessively consume alcohol.
Cerebral Hemorrhage Diagnosis
If your doctor suspects you may have bleeding of the brain based on symptoms, he or she will likely recommend a CT (computed tomography) scan. The purpose is to view the brain’s structures and determine if there is any blood in the brain.
The neurologist will typically take a medical history and conduct a neurological exam that can reveal increased pressure within the brain or any decrease in neurological functions. The doctor will look for signs like:
- Abnormal reflexes
- Changes in vision and eye movement
- Difficulty feeling sensations
- Swelling of the optic nerve from increased pressure in the brain
- Loss of movement or coordination
Tools and Tests
If the CT brain scan does not definitively confirm the presence of a cerebral hemorrhage, additional diagnostic tests may be used.
- CT angiogram uses X-rays, computers and contrast dye to provide a detailed look at the blood vessels of the brain.
- MRI (magnetic resonance imaging) or MRA (magnetic resonance angiography), which is an MRI of the blood vessels.
- Lumbar puncture (spinal tap) may be recommended if the doctor suspects an infection of the brain.
Cerebral Hemorrhage Treatment
A cerebral hemorrhage is a serious, potentially fatal medical condition that should receive immediate medical attention. If a stroke has occurred the cause (bleeding or a blood clot) must be determined so that the appropriate treatment can be started. Prompt medical treatment can minimize the damage to the brain and improve chances for recovery.
If a cerebral hemorrhage is diagnosed a variety of medical and surgical techniques are available. The type of treatment can vary depending on the abnormality that caused the bleed, the location and the size of the bleed.
A first step is often to reduce blood pressure and then address the swelling or pressure that can build up inside the brain after the blood vessel ruptures.
Your Wellstar treatment team will include a neurologist, diagnostic radiologist, interventional radiologist and neurosurgeon. Options include medication and surgery.
Medicines to treat or reduce symptoms of cerebral hemorrhage may include:
- Anticonvulsants to control seizures
- Corticosteroids or diuretics to reduce swelling
- Pain killers
The purpose of surgery is to repair or remove structures causing the bleed. If a torn artery caused the hemorrhage, surgery is needed to decompress the brain to release collected blood and repair damaged blood vessels. There are several decompression techniques, including burr hole and craniectomy or craniotomy, which involve removing a portion of the skull to perform the operation.
If the hemorrhage was caused by a cerebral aneurysm that has ruptured, the aneurysm should be surgically clipped. This is a surgical procedure to stop the blood flow to the aneurysm, which is a bulging, weak area of the artery wall.
Cerebral Hemorrhage Ongoing
The need for ongoing care and rehabilitation vary by patient. In all cases the goal is to help you regain function needed for daily living and to prevent future occurrences. Depending on the situation, including whether the hemorrhage resulted in a stroke, your Wellstar neurologist will recommend ongoing care including physical therapy, speech (or other communication) therapy, occupational therapy and lifestyle changes to reduce the chance of another cerebral hemorrhage.
Wellstar offers comprehensive rehabilitation at several convenient locations. Our trained and compassionate physical, occupational and speech therapists help patients regain strength, skills and the ability to live normal and comfortable lives.
How well a particular patient will do over time depends on the location, the size of the bleed and the amount of swelling. Possibilities include complete recovery, some loss of brain function or in some cases, some permanent loss of brain function.