Brain haemorrhage

What is a brain haemorrhage?

A brain haemorrhage is bleeding in or around the brain. It is a medical emergency that requires urgent treatment. There are several types of brain haemorrhage, which are named according to where exactly the bleeding occurs.

Bleeding can occur between the brain’s protective membranes, called the meninges. The outermost layer is called the dura mater, the middle layer is called the arachnoid mater, and the innermost layer, which lies directly against the brain’s surface, is called the pia mater.

• Subdural haemorrhage – bleeding occurs in the subdural space, the space between the dura mater and the arachnoid mater.

• Epidural haemorrhage, also known as extradural haemorrhage – bleeding occurs in the extradural space, the space between the skull and the dura mater.

• Subarachnoid haemorrhage – bleeding occurs in the subarachnoid space, the space between the arachnoid mater and the pia mater. This is most commonly caused by a burst [Link to aneurysm webpage:] brain aneurysm, although it can have other causes.

Bleeding can also occur within the brain.

• Intracerebral haemorrhage – bleeding occurs inside the brain tissue.

• Intraventricular haemorrhage – bleeding occurs inside the ventricles of the brain.

Intracerebral and subarachnoid haemorrhages are the two main types of haemorrhagic stroke. Other brain haemorrhages, including subdural and epidural haemorrhages, may result from a head injury.

What causes a brain haemorrhage?

There are many causes of blood leakage in or around the brain.

Head injuries resulting in traumatic brain injury can be caused by accidents such as road traffic collisions or falls. The injury can damage blood vessels in or around the brain, causing them to leak blood. Bleeding can occasionally develop after a head injury that initially appears minor and symptoms may not appear immediately.

This is why it is important to follow the medical advice given after the injury and seek help if concerning symptoms develop (see next section).

A brain haemorrhage can be caused by a brain aneurysm bursting. High blood pressure can also damage blood vessels in the brain over time and increase the risk of a haemorrhagic stroke.

Blood vessel abnormalities such as arteriovenous malformations (AVMs) and cavernomas have abnormally formed blood vessels that can be more likely to leak or rupture, causing a brain haemorrhage.

Certain conditions that affect blood clotting and blood-thinning medicines can also increase the risk of brain haemorrhage.

What happens in a brain haemorrhage?

Leaked blood can damage nearby brain tissue and increase pressure within the skull. The increased pressure can restrict blood flow to surrounding areas, reducing the supply of oxygen to brain cells and causing further damage.

Symptoms of a brain haemorrhage vary depending on the type and location of the bleeding, but may include:

• A sudden, severe headache that does not get better or steadily worsens

• Feeling or being sick

• Stiff neck or neck pain

• Weakness or drooping on one side of the face

• Weakness on one side of the body or in any limbs

• Sensitivity to light

• Blurred vision or loss of sight

• Sudden confusion

• Speech problems

• Loss of consciousness

• Seizures

Call 999 immediately if you or someone else develops a sudden, extremely painful headache. You should also call 999 for sudden facial weakness, weakness or numbness on one side of the body, speech problems such as slurred speech, blurred vision or loss of sight. If you are experiencing these symptoms, do not drive yourself to A&E.

How is a brain haemorrhage treated?

At hospital, a person with a suspected brain haemorrhage will usually have tests to confirm the diagnosis. Tests can include:

• Brain scans - these can help to confirm the diagnosis and identify where the bleeding has taken place in or around the brain.
  

• Blood tests - these are carried out to get more detail about the person’s blood, such as blood sugar levels and how well the blood clots. Blood pressure may also be monitored.

• Other assessments - a range of other medical assessments can be used to identify what particular issues the person is having, which can help with treatment at the next stage.

In some cases, surgery may be needed to remove collected blood, reduce pressure on the brain or repair a damaged blood vessel.

There are two main procedures that may be performed if a subarachnoid haemorrhage is caused by a burst brain aneurysm. These are:

Endovascular surgery
Tiny coils can be inserted into the aneurysm, helping to seal it and stopping blood from flowing into it. A mesh device may instead be used to divert blood flow away from the aneurysm. The coils or mesh device are placed through a thin tube called a catheter, which is passed through an artery and guided to the aneurysm.

Surgical clipping
A section of the skull is removed (called a craniotomy) to reach the aneurysm. A metal clip is then attached to the ‘neck’ of the aneurysm to stop blood from flowing into it.

Both procedures are carried out under general anaesthetic, which means the person is asleep during the procedure. The medical team will discuss details of the chosen procedure with the person beforehand, including what may happen during the recovery phase.

Medicines may be used to control blood pressure or reverse the effects of blood-thinning medicines, depending on the type and cause of the haemorrhage.

What happens after a brain haemorrhage is treated?

Following treatment for a brain haemorrhage, a person will usually need to stay in hospital to recover. They will continue to be monitored by the medical team. The length of the hospital stay will depend on the type and severity of the haemorrhage, the treatment provided and the person’s individual needs.

The person may have rehabilitation to help manage the physical, cognitive or emotional impact of the brain haemorrhage. This can take place within the hospital, at a specialist brain injury rehabilitation unit or through community-based teams.

A person may be able to return directly home from hospital, but they will need to continue resting. The time needed to recover and return to usual activities varies from person to person.

For more information on these next stages, see Treatment and rehabilitation.