This article highlights a common, and a fatal condition called brain hemorrhage. It includes the importance of blood pressure as a causative factor. It explains the measures to assess and treat the condition.
A brain hemorrhage is the bursting of an artery in the brain. This discharge of blood can interrupt the normal circulation to the brain, leading to stroke, which occurs when part of the brain lacks oxygen. Strokes can cause permanent or temporary damage to the brain.
Bleeding within the brain can also raise the pressure inside the skull to dangerous levels. This high pressure can cause the hemorrhage to bleed quicker, leading to a vicious cycle of destruction within the brain. Brain hemorrhages can be deadly, and the damage that is caused by them is determined by the size of the hemorrhage, the amount of swelling in the skull, and how quickly the bleeding is controlled.
The types of brain hemorrhage are:
1. Subarachnoid Hemorrhage:
Subarachnoid hemorrhage usually occurs after trauma when the cortical surface vessels are injured and bleed into the subarachnoid space. Non-traumatic subarachnoid hemorrhage is commonly due to the rupturing of the cerebral aneurysm. During the rupture of an aneurysm, the blood can flow into the subarachnoid space. Other causes of subarachnoid hemorrhage include blood thinners, arteriovenous malformations (AVM), trauma, or idiopathic causes.
2. Intraparenchymal Hemorrhage:
Non-traumatic intraparenchymal hemorrhage usually occurs secondary to hypertensive damage to cerebral blood vessels, ultimately bursting and bleeding into the brain. Other causes may include rupture of an aneurysm, an arteriovenous malformation, arteriopathy, tumor, infection, or venous outflow obstruction. Intraparenchymal hemorrhage can also be caused by penetrating and non-penetrating trauma.
3. Epidural Hemorrhage:
Epidural hemorrhage can occur when the blood dissects into the latent space between the dura and inner table of the skull. Most commonly, this happens after a skull fracture in 85% to 95% of cases. In addition, to this there can be damage to the venous or an arterial vessel, allowing the blood to dissect into the potential epidural space resulting in the epidural hematoma. The most commonly damaged vessel is the middle meningeal artery below the skull's temporoparietal region.
4. Subdural Hemorrhage:
The multiple causes of subdural hemorrhage include head trauma, vascular abnormality rupture, coagulopathy, and spontaneous. Head trauma is the usual cause of the brain's motion relative to the skull, stretching and breaking the blood vessels crossing from the brain to the skull. If the blood vessels are damaged, they can bleed into the subdural space.
There is no symptom in most patients, and the person comes to an emergency with a history of sudden unconsciousness. When blood pressure is checked and found to be elevated, and a CT scan shows a large amount of blood in the brain. So, a seemingly normal person dies due to a brain hemorrhage. It is a common presentation of patients with high blood pressure. Fortunately, some patients get:
Sudden, severe headaches (thunderclap headaches).
Tingling or numbness in the arms or legs.
Paralysis on one side of the body.
Chest pain when their blood pressure rises.
Risk factors for brain hemorrhage:
The common risk factor for brain hemorrhage is hypertension.
Antiplatelet and anticoagulant medications can also increase the risk of a spontaneous brain hemorrhage.
Cerebral amyloid angiopathy is linked to a build-up of amyloid proteins in the arterial walls, making them more prone to rupture.
The rupture of an intracranial aneurysm (subarachnoid hemorrhage) may be spontaneous, precipitated by exertion, or from hypertension.
It is very distressing to see the patients dying with a brain hemorrhage. Medically, this is called intracranial bleeding or hemorrhage. A simple cycle leads to this fatal condition. High blood pressure leads to increased pressure inside the blood vessels, and brain vessels being delicate, ruptures leading to hemorrhage or blood flow into the brain. Most commonly, increased blood pressure is the culprit. Most of the time, patients do not recover and succumb to death.
Could we prevent this death? The answer is yes. The simple measure to prevent such death is to keep the blood pressure under control.
As we discussed earlier, we need to control blood pressure. But, we can control it only if we know that we have high blood pressure. So, one has to be vigilant for the symptoms mentioned above. Also, every person in his or her 40s or 50s should get their blood pressure checked periodically. It is more important to be cautious if they have a family history of high blood pressure, obesity, diabetes, smoking, or other risk factors. If the patient is a known case, he should check blood pressure more frequently and with any new symptoms.
Once detected, we should make changes in our lifestyle to control high blood pressure like a low salt diet, regular exercise, reducing weight, having green leafy vegetables, avoiding meat, smoking, and alcohol. Also, along with this, we should regularly take medicines prescribed by the doctor.
The common misconception is that many patients discontinue medicine once blood pressure is controlled because they think it is cured and do not need any medication. Patients with blood pressure need to be on medicine for life long with the change in dosage at regular intervals.
One should buy an electronic blood pressure apparatus for home BP measurements, as these are more reliable than a single reading taken in the hospital. One should make the chart of blood pressure and get it reviewed by the doctor. Some blood pressure medicines can cause side effects, but this should be discussed with the doctor and medicine, or the dose should be modified, but medicine should not be discontinued on its own.
I hope this helps you increase your knowledge regarding this condition, and your awareness can save some lives.
Brain hemorrhage occurs due to the brain bursting of the arteries causing localized bleeding, and the person can lead to death within 12 to 24 hours if the bleeding is extensive and rapid. About 30 to 60% of people with intracerebral hemorrhage die, and also, patients with ruptured aneurysms or subarachnoid hemorrhages also do not survive long enough to reach the hospital.
Brain hemorrhage, also called a brain bleed, occurs due to:
- Brain tumor.
- High blood pressure.
- Injury or head trauma.
- Aneurysm leading to stroke.
- Blood vessel abnormalities.
- Amyloid angiopathy.
- Bleeding disorders.
- Liver disease.
The brain hemorrhage can be a congenital deformity or may occur due to other health conditions where the brain bleed-
- Can reduce the oxygen delivery to the brain.
- Can weaken the blood vessel.
- Creates extra pressure in the brain.
- Kills the brain cells.
Blood irritates the tissues around the brain, creates pressure on the brain tissue, and initially, the symptoms will be unknown. Later, patients will experience a combination of symptoms like:
- Severe headache.
- The first episode of seizure.
- Change in vision.
- Loss of consciousness, coordination, and balance.
- Difficulty in swallowing.
- Abnormal taste sensation.
- Weakness in the arms or legs.
- Difficulty in reading and writing.
- Hand tremors.
- Difficulty in speech.
For people with a brain hemorrhage, the recovery rate is slow, and many deaths occur within two days. In contrast, very few people recover completely or near-complete functioning within 30 days of stroke. After the hemorrhagic stroke, the survival rate is 26% for a period of five years, and a better survival rate prognosis is seen among:
- Young people.
- People without hypertension.
- Without alcohol intake.
- Without diabetes mellitus.
As stress can increase blood pressure, it causes the blood vessel walls to rupture, leading to brain hemorrhage. It is a type of hemorrhagic stroke where strong emotions like mood upset or anger raise the blood pressure and subsequently results in brain hemorrhage.
The four types of hemorrhage are:
- Epidural hematoma - Collection of blood outside of a blood vessel.
- Subdural hematoma - Collection of blood on the surface of your brain associated with traumatic brain injury.
- Subarachnoid hemorrhage - Collection of blood between the brain and the tissue covering the brain.
- Intracerebral hemorrhage - A life-threatening condition causing bleeding inside the brain.
A brain hemorrhage can be prevented by:
- Treating high blood pressure.
- Do not smoke.
- Do not consume unnecessary drugs like cocaine.
- Drive carefully, and wear your seat belt.
- If you ride a motorcycle, always wear a helmet.
- In case of an aneurysm, go for surgery to avoid bleeding.
Brain hemorrhage is a life-threatening condition where its seriousness and the rate of brain bleeding depends on:
- Age of the patient.
- The overall health of the patient.
- Location inside the skull.
- The intensity of the bleed.
- Amount of time taken to pass between the bleed and treatment.
The parts of the brain damaged by the hemorrhage are:
- Epidural hematoma -Bleeding occurs between the tough outer membrane covering the brain.
- Subdural hematoma - Bleeding occurs between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain.
- Subarachnoid hemorrhage - Bleeding occurs in the subarachnoid space (the area between the arachnoid membrane and the pia mater surrounding the brain).
- Intracerebral hemorrhage - The bleeding occurs in the lobes, pons, and cerebellum of the brain.
Last reviewed at:
07 Jul 2021 - 4 min read
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