A brain hemorrhage is bleeding in and around the brain. Weak blood vessels, high blood pressure, trauma, brain injury and drug abuse can cause brain hemorrhage.

What are the symptoms of brain hemorrhage?

The symptoms of brain hemorrhage are similar to that of stroke like numbness in hands and legs, weakness in the body, especially on one side, trouble speaking, walking, and difficulty in performing normal activities. Nearly about 10% of brain strokes fall under this category of strokes.

The symptoms of brain hemorrhage depend on the area of the brain that is affected. If the part of the brain that controls vision is involved, then there will be problems with vision; if the region that controls balance and coordination gets affected, then there will be numbness or weakness in the arms and legs. Bleeding in the lower brain (brain stem) that controls most of the body functions, may lead to coma. Sometimes, the symptoms may come abruptly and become prominent and sometimes may progress very slowly.

Bleeding inside the brain does not cause any symptoms as the brain doesn’t have the ability to sense itself, but when bleeding occurs within the coverings of the brain – a very severe headache is eminent.

What are the types of brain hemorrhage?

Based on the position of their occurrence in brain, hemorrhages are of these types: intracranial – inside the skull; intracerebral – within the brain; sub-arachnoid – between the brain and its covering, and subdural or epidural – below or above the dura (covering of the brain).

What are the causes of brain hemorrhage?

There are many causes of brain hemorrhage including high blood pressure, weakening of arterial walls and formation of blood clots, brain aneurysm, arteriovenous malformations (AVM) and cancers that are metastatic. In addition, the deposition of amyloid proteins in the blood vessels in the elderly may lead to hemorrhagic stroke. Similarly, some prescription drugs and drug abuse can also increase the risk of brain stroke.

 How is a brain hemorrhage diagnosed?

The physician after suspecting stroke evaluates the patient medically and if the examination reveals any sort of loss of sensations, disturbances in speech or weakness in the limbs, then radiological examination (CT or MRI) is advised to determine the location of bleeding.

Once the bleeding inside or around the brain is noted, the exact cause of bleeding needs to be determined – for which, additional tests may be recommended to know the presence of any abnormal blood vessels. Next, based on the diagnosis, treatment is planned.

What is the treatment?

The patients are monitored expeditiously and as an initial treatment modality, breathing and blood pressure is stabilized and monitored. To provide enough oxygen to the brain, a ventilator is used and intravenous fluids are given along with medications to the patient. As a special treatment measure pressure inside the skull, blood oxygen levels and heart rhythms’ monitoring is done. After stabilizing the patient, subsequent measures to address the bleeding are taken very rapidly after thorough due diligence. Based on the size and location of the hemorrhage, surgical intervention may be decided.

During the course of the treatment several medicines are given to the patient to control swelling around the affected area, to reduce pain, to control blood pressure and to prevent seizure.

Dr Vikram Sharma

Consultant Neurologist