Bleeding in the brain

Bleeding in the brain can be dangerous and there are two main types of bleeding: spontaneous and traumatic.

Traumatic bleeding occurs after a significant blow to the head, such as could happen in a car crash.

Spontaneous bleeding occurs when the cause is an underlying medical condition, such as a leaking blood vessel.

The symptoms caused by active bleeding in the brain can vary from none at all to headaches, nausea, leg or arm weakness, speech problems, seizures or loss of consciousness.

The most common cause is a haemorrhagic stroke, where a blood vessel near the surface of the brain breaks due to high pressure and starts to leak blood.

The symptoms are often identical to a stroke caused by a blockage of the blood vessels (ischaemic stroke), as both stop the delicate brain tissue from getting the blood supply it needs.

The treatment of an ischaemic stroke involves medication to thin the blood and dissolve blood clots. But in some cases this can make the bleeding worse.

This is why one of the first investigations, when someone is having a stroke, is a scan of the brain to see if their stroke is caused by bleeding or not.

In a haemorrhagic stroke, the best treatment is often surgery to stop the blood loss and remove any blood that is compressing the brain.

If you or someone with you becomes unwell very suddenly, you should get help immediately by calling 999 straight away.

The main symptoms of bleeding in the brain include:

• Headache: this may be very sudden and sharp 
• Weakness: usually on one side of the body, either in the face, arm or leg
• Speech problems: such as suddenly struggling to produce or understand speech
• Vomiting: which may occur rapidly, often with a headache
• Seizures: involving a fall to the ground and shaking, or part of the body becoming stiff
• Coma or losing consciousness

The most common cause is a burst blood vessel, leading to bleeding and a stroke.

Other causes may include the following: 

• Aneurysms
• Arteriovenous malformations (AVMs)
• Subarachnoid haemorrhage
• Head trauma
• Blood-thinning medication
• Genetic conditions that make you more likely to bleed

Other causes of bleeding in the brain can include:

• Aneurysms: a bulging of a blood vessel that can occasionally enlarge and burst
• Arteriovenous malformations (AVM): a tangle of blood vessels that you are born with
• Subarachnoid haemorrhage: bleeding between the membranes covering the brain
• Blood-thinning (anticoagulant) drugs: these increase the risk of a bleed occurring

Your consultant will examine you, take a history of what happened, and suggest some tests.

One of the tests will likely be a scan of your head, either a CT or MRI scan. Sometimes these scans may also reveal the underlying cause of the bleed.

Once bleeding has been confirmed, and the cause found, your consultant will work with you to create a treatment plan.

This plan will aim to reduce and manage any symptoms you have left after the bleed, to ensure you retain your quality of life.

The plan will also aim to reduce the chance of another bleed occurring.

Depending on the cause of the bleed, this treatment might involve lifestyle changes, changes to existing or new medication, or even surgery.

Rest assured that your needs will be at the centre of the treatment plan.

How is bleeding risk from high blood pressure reduced?

Poorly controlled blood pressure is one of the leading risk factors for haemorrhagic stroke. This is because the raised blood pressure puts the walls of the blood vessels under strain.

Eventually, in a small number of people, this wall will break and blood will leak out, causing a stroke.

Your consultant will work with you to create a treatment plan to control your blood pressure if needed.

This plan is likely to include diet and lifestyle factors, such as exercise, and blood pressure medication.

Once you have been started on a new medication, your consultant will follow up with you to ensure that your blood pressure is improving and that you are tolerating your new medication well.

How are bleeding risks from aneurysms reduced? 

Many people have brain aneurysms without ever knowing, and for some they will never cause any problems.

Most people that are discovered to have a brain aneurysm either have them found after having had a bleed, or after having a brain scan for another reason.

Once an aneurysm has been discovered, your consultant will work with you to ensure that you fully understand your diagnosis and to come up with a bespoke treatment plan.

Depending on the size, location and whether the aneurysm has bled, your consultant may suggest a number of treatment options.

These could include lifestyle modifications, medication for blood pressure control, and possibly procedures or surgery.

The procedures suggested could include endovascular coiling, where a wire is passed through a blood vessel in the leg up to your brain and a small coil is placed to block off the aneurysm.

Occasionally your consultant may suggest a neurosurgical operation to remove the aneurysm.

How are bleeding risks from blood-thinning drugs reduced?

If you are on a blood-thinning (anticoagulant) drug, chances are you have been prescribed it for a very good reason.

If you are on a blood-thinner and your risk of having a brain bleed is high (for instance, you are known to have a brain aneurysm), a well thought out management plan is key.

Your consultant will work with other specialists, including your own doctor, and yourself to come up with a treatment plan that balances the risks and benefits of your blood-thinning drug.