Brain Haemorrhage (Brain Bleed) Treatment in Delhi, India

A brain haemorrhage, also known as a cerebral haemorrhage or intracranial haemorrhage, occurs when there is bleeding in or around the brain. This bleeding can result from a variety of causes that can limit the oxygen supplied to the brain, causing headaches, nausea, vomiting, tingling in the extremities, or facial paralysis. If not promptly diagnosed and treated, brain haemorrhage can lead to serious complications, emphasising the critical importance of timely medical intervention and treatment.

There are many types of brain haemorrhages.The most common ones include:

Epidural Hematoma

Epidural hematoma occurs when there is bleeding between the dura mater, the tough outer membrane covering the brain, and the inner surface of the skull. This type of haemorrhage is typically caused by head trauma, such as skull fractures resulting from accidents or falls. The trauma may lead to tearing of blood vessels, causing bleeding into the space between the skull and the dura mater.

Subdural Hematoma

Subdural hematoma refers to bleeding that occurs between the dura mater and the arachnoid membrane, which is the middle layer of the protective coverings of the brain. Head trauma is the most common cause of subdural hematoma. The bleeding usually results from tearing of blood vessels bridging the brain surface and the dura mater. Chronic subdural hematomas can also develop gradually, often in elderly individuals, due to minor head injuries or spontaneous bleeding.

Subarachnoid Haemorrhage

Subarachnoid haemorrhage is characterised by bleeding into the space between the arachnoid membrane and the pia mater, the innermost membrane covering the brain. The most common cause of subarachnoid haemorrhage is the rupture of a cerebral aneurysm—a weakened area in a blood vessel wall. Other causes include head trauma, arteriovenous malformations (AVMs), and bleeding disorders.

Intracerebral Haemorrhage

Intracerebral haemorrhage involves bleeding within the brain tissue itself, typically due to the rupture of small blood vessels. Hypertension (high blood pressure) is the leading cause of intracerebral haemorrhage. Other causes may include arteriovenous malformations (AVMs), aneurysms, trauma, bleeding disorders, and the use of anticoagulant medications.

Intraventricular Haemorrhage

Intraventricular haemorrhage occurs when there is bleeding within the brain's ventricular system, responsible for cerebrospinal fluid circulation. This type of haemorrhage is often associated with other types of brain haemorrhages, such as intracerebral haemorrhage or subarachnoid haemorrhage. Causes of intraventricular haemorrhage may include head trauma, hypertension, or structural abnormalities in the brain's blood vessels.

The symptoms of a brain haemorrhage can vary widely depending on factors such as the location, size, and severity of the bleeding. It's essential to recognize these symptoms promptly as they can indicate a serious medical emergency requiring immediate attention. Here's a closer look at the common symptoms associated with a brain haemorrhage:

• Sudden and Severe Headache: A sudden and severe headache, often described as the worst headache of one's life, is a hallmark symptom of a brain haemorrhage. This headache can occur abruptly and may differ from typical headaches in intensity and duration.
• Nausea and Vomiting: Nausea and vomiting are common symptoms of a brain haemorrhage and may accompany the sudden onset of a severe headache. These symptoms can be persistent and may occur repeatedly, leading to discomfort and distress.
• Weakness or Numbness: Weakness or numbness, particularly on one side of the body, may occur as a result of a brain haemorrhage affecting specific areas of the brain responsible for motor function and sensation. This weakness or numbness may affect the face, arm, or leg on one side of the body.
• Difficulty Speaking or Understanding Speech: Difficulty speaking or understanding speech, known as aphasia, may occur if the area of the brain responsible for language function is affected by the haemorrhage. This symptom can manifest as slurred speech, difficulty finding words, or an inability to comprehend spoken language.
• Loss of Consciousness: In severe cases, a brain haemorrhage may cause a loss of consciousness or altered level of consciousness. This loss of consciousness may range from brief episodes of confusion to prolonged periods of unconsciousness.
• Seizures: They are sudden, uncontrolled electrical disturbances in the brain, and may occur as a result of a brain haemorrhage. These seizures can manifest as convulsions, muscle rigidity, altered consciousness, or unusual movements.
• Vision Changes: Some individuals may experience vision changes such as blurred vision, double vision (diplopia), or partial vision loss, which may occur if the haemorrhage affects areas of the brain involved in visual processing. These changes in vision may be temporary or permanent, depending on the extent of the damage.
• Difficulty Walking or Balancing: Difficulty walking or balancing, known as ataxia, may occur if the haemorrhage affects areas of the brain responsible for coordination and balance. This symptom can manifest as unsteadiness, stumbling, or difficulty maintaining an upright posture.

Recognizing the symptoms of a brain haemorrhage is crucial for prompt medical evaluation and intervention. If one experiences any of these symptoms, especially sudden and severe headache accompanied by other neurological symptoms, they must seek immediate medical attention to rule out a brain haemorrhage or other serious medical conditions.

Diagnosing a brain haemorrhage typically involves a combination of medical history review, physical examination, and imaging tests such as CT scans. These tests can help determine the location and extent of the bleeding, as well as any underlying causes. Here's a detailed explanation of the diagnostic process:

Medical History Review

The diagnostic process often begins with a thorough review of the patient's medical history, including any past medical conditions, previous episodes of headaches or neurological symptoms, medications, and recent injuries or trauma.

Physical Examination

A comprehensive physical examination is conducted to assess the patient's neurological status and identify any signs or symptoms suggestive of a brain haemorrhage. The examination may include tests of sensory function, reflexes, muscle strength, coordination, and cognitive function.

Imaging Studies

• Computed Tomography (CT) Scan: A CT scan of the head is often the first-line imaging study used to diagnose a brain haemorrhage. This imaging modality can quickly and accurately detect the presence of bleeding in the brain and assess its location, size, and extent. A CT scan can also help differentiate between different types of brain haemorrhages, such as subdural hematoma, epidural hematoma, intracerebral haemorrhage, or subarachnoid haemorrhage.
• Cerebral Angiography: Cerebral angiography may be performed to visualise the blood vessels in the brain and identify any abnormalities, such as aneurysms, arteriovenous malformations (AVMs), or vascular tumours that may be contributing to the haemorrhage. This invasive imaging procedure involves injecting a contrast dye into the blood vessels and obtaining X-ray images to assess blood flow and vessel integrity.

Lumbar Puncture (spinal tap)

In cases where subarachnoid haemorrhage is suspected but not detected on initial imaging studies, a lumbar puncture or spinal tap may be performed to analyse cerebrospinal fluid for evidence of bleeding (xanthochromia) or elevated red blood cell count.

Laboratory Tests

Laboratory tests, such as complete blood count (CBC), coagulation studies, and blood chemistry tests, may be ordered to assess for any underlying medical conditions or factors that may predispose to bleeding, such as coagulopathies or thrombocytopenia.

Here are some of the common treatment options for brain haemorrhages:

Medications

• Blood pressure medications: Controlling high blood pressure is crucial to prevent future haemorrhages and reduce pressure on the brain.
• Anticonvulsants: These medications can help prevent seizures, which are a common complication of brain haemorrhages.
• Diuretics: These medications help reduce swelling in the brain, which can relieve pressure and improve symptoms.

Surgery

• Craniotomy: Craniotomy surgery involves removing a portion of the skull to access and remove the blood clot. It may be necessary for large or severe bleeds, or if the bleed is putting significant pressure on the brain.
• Minimally invasive surgery: Minimally invasive surgery is Newer techniques like stereotactic clot aspiration can remove smaller clots through a narrow tube inserted into the brain.
• Aneurysm repair: If the haemorrhage is caused by a ruptured aneurysm, surgery may be needed to clip or coil the aneurysm to prevent further bleeding.
• Aneurysm Coiling: A less invasive procedure where tiny platinum coils are inserted into the aneurysm to block blood flow and promote clotting.

Other Therapies

• Rehabilitation: After treatment, many patients require rehabilitation therapy to help regain lost function and improve their quality of life. This may include physical therapy, occupational therapy, and speech therapy.
• Supportive care: This includes managing pain, preventing complications like infection, and providing emotional support to the patient and their family.

Emerging Treatments

• Stem cell therapy: Research is ongoing on the use of stem cells to repair damaged brain tissue after a haemorrhage.
• Gene therapy: Gene therapy could potentially address underlying genetic factors that contribute to some types of haemorrhages.

Complications of a brain haemorrhage can be severe and may include:

• Brain damage: Bleeding and increased pressure within the skull can damage brain tissue, leading to neurological deficits.
• Permanent disability: Depending on the extent of the brain damage, individuals may experience long-term physical or cognitive impairments.
• Death: In severe cases, a brain haemorrhage can be fatal, particularly if not promptly diagnosed and treated.

Early intervention can significantly improve outcomes and reduce the risk of complications and so one must seek medical attention immediately if they experience any symptoms suggestive of a brain haemorrhage.

What are the factors options to consider for choosing a brain haemorrhage treatment?

Treatment options for brain haemorrhages depend on several factors, including:

• The type and location of the bleed: Different types of haemorrhages require different approaches.
• The size and severity of the bleed: Larger or more severe bleeds may require more aggressive treatment.
• The patient's overall health: Underlying medical conditions can influence treatment choices.

What is the outlook/prognosis for brain haemorrhage?

The prognosis for brain haemorrhage varies based on factors like size, location, and timely medical intervention. It can range from favourable with smaller bleeds and prompt treatment to poor with larger, more severe haemorrhages causing significant brain damage or complications.

What is the distinction between a brain haemorrhage and a stroke?

A brain haemorrhage occurs when there is bleeding in or around the brain, whereas a stroke refers to a sudden disruption of blood flow to the brain, often caused by a clot or blockage.

Is it possible for individuals to recover from brain haemorrhages?

Yes, with prompt medical intervention and appropriate treatment, individuals can recover from brain haemorrhages. However, the extent of recovery depends on factors such as the severity of the haemorrhage and any resulting neurological deficits.

Are there measures to prevent brain haemorrhages?

While some risk factors for brain haemorrhages cannot be controlled, such as age or family history, certain lifestyle modifications such as managing hypertension and avoiding head injuries can help reduce the risk of brain haemorrhages.

What are the potential consequences of a brain haemorrhage?

The aftermath of a brain haemorrhage may include neurological deficits such as paralysis, speech impairment, cognitive impairment, or changes in behaviour, depending on the location and severity of the bleed.

Can individuals survive with a brain haemorrhage?

Survival from a brain haemorrhage depends on various factors, including the size, location, and promptness of medical intervention. Many individuals can survive with appropriate treatment and rehabilitation.

How long does it take to recover from brain haemorrhage surgery?

Recovery from brain haemorrhage surgery varies depending on the individual's overall health, the extent of brain damage, and the type of surgery performed. It may take weeks to months for complete recovery, and rehabilitation may be necessary.

Is it possible for brain haemorrhages to heal without surgery?

In some cases, small or mild brain haemorrhages may resolve on their own without the need for surgical intervention. However, close medical monitoring and supportive care are essential to ensure optimal healing.

Who is vulnerable to brain haemorrhages?

Individuals with risk factors such as hypertension, arteriovenous malformations (AVMs), aneurysms, head trauma, or certain medical conditions affecting blood clotting are at increased risk for brain haemorrhages.

What are the signs that indicate a brain haemorrhage?

Warning signs of a brain haemorrhage include sudden and severe headaches, nausea, vomiting, weakness or numbness, difficulty speaking or understanding speech, loss of consciousness, seizures, vision changes, and difficulty walking or balancing.

Which medical specialists manage brain haemorrhages?

Neurologists, neurosurgeons, and critical care specialists are among the medical professionals who treat brain haemorrhages. Rehabilitation therapists may also be involved in the recovery process.

Reviewed By Dr Vivek Kumar - Senior Director Neurosciences, Neurology on 9 Aug 2024.