Brain Bleed

Brain Bleed

A brain bleed can occur after a severe trauma to the head. Blood vessels within the brain rupture causing bleeding on the brain. Here we explain the various types of brain bleed. Seek urgent medical attention with any head injury as they can be fatal.

Acute Subdural Hematoma

An acute subdural hematoma is a blood clot which develops between the brain and the dura mater (the brains outer covering). This is caused by a head injury which tears the veins on the brains surface.

Symptoms of an Acute Subdural Hematoma

  • Increasingly severe headache.
  • Dilated pupil on the injured side.
  • Slow pulse.
  • High blood pressure.
  • Vomiting.
  • Unconsciousness.

Causes

The cause of an acute subdural hematoma is an impact to the head. This may be from a fall, road traffic accident or sporting injury, such as being hit by a hard ball.

ASH's are among the most dangerous of all head injuries. They account for 10-20% of all traumatic brain injuries and around 30% of all fatal head injuries.

Treatment

  • Seek medical attention immediately.
  • Once at the hospital, a CT scan may be undertaken to determine the cause and extent of the injury.
  • Surgery is usually required to remove the blood clot and stop the bleeding.
  • Small hematomas may not require surgery.
  • Following surgery, close observation is required.
  • A significant number of deaths from ASH's occur in the days after surgery due to pressure on the brain or underlying brain injury.

Chronic Subdural Intracranial Hematoma

A chronic subdural intracranial hematoma is a blood clot on the surface of the brain, between the brain and the dura or thick outer lining. This is a chronic condition as the clot forms slowly over the course of several days.

Symptoms

A headache which gets gradually worse over several days. The patient may have a loss of memory and confusion. Other symptoms include lethargy, nausea, vomiting, and behavioral changes as well as weakness, impaired vision or even seizures.

Causes

Chronic subdural intracranial hematomas usually occur in those over the age of 60. Most often it is due to brain atrophy or wasting/shrinkage which can happen in old age or due to other medical conditions. The shrinkage can cause tearing of minor blood vessels on the brains surface, which then bleeds into the space. Other causes include blood thinning medications, alcohol abuse and seizures.

Treatment

If this condition is suspected, seek medical attention as soon as possible. CT or MRI scans can be used to diagnose the condition and confirm the extent of the bleed. In most cases, the blood can be drained and so pressure released by drilling a small hole in a skull. 80-90% of cases show considerable improvement after drainage, with few long-term side-effects.


Subarachnoid Intracranial Hematoma

A subarachnoid intracranial hematoma is a bleed into the subarachnoid space, between the brain and the thin tissue that covers it. It is most frequently caused by a head injury, although can occur due to other medical conditions.

Symptoms of a subarachnoid intracranial hematoma

Symptoms include a severe headache which is often located at the back of the head. The patient may experience dizziness, confusion, irritability, nausea, and vomiting. They will dislike and avoid bright lights. There will be changes in pulse and breathing rate along with possible seizures or unconsciousness.

Causes

Subarachnoid intracranial hematomas are usually caused by a head injury, such as a direct impact to the head from a hard object, a fall or a car accident.

This particular hematoma can also occur due to the rupture of a cerebral aneurysm. These occur in those between the ages of 20 and 60, are slightly more common in women than men and those with high blood pressure or who are regular smokers.

Treatment

Seek medical attention immediately. A doctor will perform an examination and if a hematoma is suspected, a CT scan will be performed. Other investigations such as an MRI scan or angiography may also be used.

Surgery is usually required with the aim of removing the blood and decrease pressure on the brain. If surgery is following an aneurysm then the aim is to repair an aneurysm and drain the blood. The patient will then be closely monitored for changes in their condition which may indicate further bleeding or brain injury.


Intracerebral Hematoma

An intracerebral hematoma occurs when one or more blood vessels in the brain rupture, usually as a result of a head injury. It is a medical emergency which can be fatal and so all head injuries should be investigated.

Symptoms of an intracerebral hematoma

Symptoms include a severe headache, nausea, dizziness, confusion, and loss of consciousness. The patient may have a loss of feeling or weakness in the limbs on one side or even a seizure.

Causes

An intracerebral hematoma usually results after a forceful impact to the head. This can be a sporting accident (such as a collision or being hit with a hardball, stick or racket) or from a fall or road traffic accident etc.

Very rarely, an intracerebral hematoma may occur in the absence of a head injury. In these cases, blood disorders (such as hemophilia or anemia), chronic high blood pressure or drug overdoses may be the cause.

Treatment of an intracerebral hematoma

Seek medical attention immediately - call an ambulance. The ambulance staff will try to stabilise the patient and will rush the patient to the hospital and on arrival at the hospital, emergency surgery is required. This aims to stop the bleeding and relieve the pressure build-up in the skull.

After successful surgery, the patient will be kept under close observation in hospital for several weeks. Further tests will be done to check for brain damage and to ensure that all bleeding has stopped. Once released from the hospital the patient will require regular check-ups and long-term medication.

This article has been written with reference to the bibliography.