What to Know About Brain Bleeds

When most people think of a “bleed,” they think of bleeding visibly from the body—a cut or abrasion, for example, where a wound is deep enough to release blood onto a person’s skin. A brain bleed, however, is different. It’s an intracranial hemorrhage—a severe bleed inside the skull—which is not observable externally. Intracranial hemorrhages require treatment by a neurologist or neurosurgeon; some strokes can be hemorrhagic.

Are You at Risk?

The most common risk factors for a brain bleed include:

• Head trauma
• Bleeding disorders (a group of conditions that occur when the blood cannot clot properly)
• Antiplatelet agents such as aspirin that prevent blood clots from developing
• Anticoagulants such as Coumadin, Xarelto, or Eliquis
• Uncontrolled high blood pressure or diabetes
• Smoking or drinking heavily, or using illegal drugs
• Atherosclerosis (fatty deposits in arteries)
• Vascular malformations (abnormalities in blood vessels or blood vessel walls)
• Aneurysm (a type of vascular malformation)

Types of Brain Bleeds

Bleeding can occur in the brain, or between the brain and the skull. Each type can have a variety of causes and treatments.

Bleeds are named based on where they occur. For example, the following are four types of intracranial hemorrhages that are defined by location and cause:

• Intraparenchymal, or within the brain. This can be caused by a hemorrhagic stroke, when a weakened blood vessel within the brain ruptures and bleeds into the surrounding areas. It can also be caused trauma or injury, vascular malformation or a tumor.
• Subdural, which is inside the dura but outside the brain. The dura is comprised of two layers of tough tissue that cover and protect the brain and spinal cord. This bleed is usually caused by trauma.
• Epidural, which is inside the skull but outside the dura. This type of hemorrhage is also mostly the result of trauma.
• Subarachnoid, which is on the surface of the brain. This type of hemorrhage is cause by trauma or an aneurysm.

Symptoms of a Brain Bleed

A person experiencing a brain bleed will usually know that something is wrong. Symptoms include:

• Sudden and severe headache
• Seizure
• Loss of balance, coordination, and motor or movement skills—even loss of consciousness
• Extreme tiredness
• Weakness in a limb, often on just one side
• Loss of vision and light sensitivity
• Loss of normal taste sensations
• Nausea and vomiting
• Stiff neck
• Difficulty breathing
• Abnormal heart rate

IMPORTANT: Persons experiencing the symptoms of a brain bleed should immediately go to an emergency room to maximize chances for survival and recovery.

What Can Be Done for a Brain Bleed

Depending upon the location, size, cause and severity of a brain bleed, surgery may be required to help reduce swelling and pressure, remove a blood clot or tumor, stop further bleeding or repair malformed blood vessels. Small brain bleeds may not require surgery; patients can work to prevent another occurrence by discussing how to mitigate risk factors with their physician.

Swelling or tumors are usually controlled with intravenous steroids. Anti-epilepsy drugs may be prescribed to help prevent seizures. Other medications may be needed to control blood pressure or other risks factors. Those who have been prescribed blood-thinning medications may need to stop taking them during recovery.

What to Expect While Recovering From a Brain Bleed

A brain bleed is a serious medical event. There are many factors that contribute to a successful brain bleed recovery, and no two patients are the same. Age, genetic predisposition to certain conditions and general health can all affect the speed of recovery, which can be as short as a few days or as long as several months.

Many patients will need rehabilitation, which may be lengthy; unfortunately, not all brain injuries can be reversed. Again, the speed with which a person seeks treatment is critical to recovery time.

A patient’s recovery team may include not only a neurologist and neurosurgeon, but also rehabilitation specialists and physical, occupational or speech and language therapists. Those in recovery may feel very tired but also have trouble sleeping. Headaches, “odd” bodily sensations and changes in taste, smell or vision are other symptoms that can occur during recovery.

There will be good days and bad during the recovery process. Perseverance and a positive mental outlook are two important components that can make the likelihood of a full recovery much more possible.