Cerebral hemorrhage

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 1, 2016
StartDiseasesCerebral hemorrhage

A cerebral hemorrhage is a very serious condition involving the bleeding within the brain. It is also referred to as intracerebral hemorrhage. A hemorrhage of this variety can lead to strokes, seizures and may cause permanent physical disabilities as well as intellectual disabilities. A leading cause of hemorrhages is high blood pressure (hypertension), which is just one reason why physicians so often warn people to closely monitor their blood pressure.


Definition & Facts

A stroke occurs when brain cells start to die due to lack of oxygen caused by blocked blood flow to the brain. An aneurysm is a bulging vein that could possibly burst, and when it occurs in the brain, it's called a brain aneurysm. If an aneurysm occurs in a cerebral artery and ruptures, it can cause a cerebral hemorrhage. Most of the time, a hemorrhage is caused by high blood pressure although there are many other factors involved.

When a cerebral hemorrhage takes place, the patient survives about 65% of the time. 20% of those who have a hemorrhage regain functional independence. 50% of patients who suffer a hemorrhage will have neurological deficits. About 10% of those who have a hemorrhage have a seizure within the next 30 days. 

Symptoms & Complaints

There are different symptoms depending on what part of the brain the hemorrhage has occurred in and how much brain matter has been affected. Sometime the symptoms appear all at once. In other instances,the symptoms occur and develop gradually to the point that they become an issue. The most common warning sign of a cerebral hemorrhage is a sudden headache and vomiting. Here are the other main warning signs:


There are a number of causes of cerebral hemorrhages, and sometimes there is more than one cause. Sometimes blood vessels become disorganized, a condition known as arteriovenous malformation.

Traumatic brain injuries are a major cause. These occur most often as a result of falls. Unintentionally being struck in the head is the second leading cause of traumatic brain injuries. Motor vehicle crashes such as those that occur in a car or motorcycle are the third leading cause of traumatic brain injury in the United States.

Bleeding disorders and aneurysms are also linked to hemorrhages. Some people are born with atypical blood vessels as a result of a congenital disorders. Others develop vasculitis, a condition that involves the inflammation of the blood vessels which can lead to hemorrhages. Those who take anticoagulants are also more susceptible to hemorrhages.

As people age, they sometimes develop a change in their blood vessel walls known as cerebral amyloid angiopathy. This condition causes small bleeds that may go unnoticed until there is a massive hemorrhage. People with sickle-cell disease and hemophiliacs have a lower amount of blood platelets (thrombocytopenia), making them susceptible. There is also a correlation between chronic liver disease and hemorrhages. 

Smoking and alcohol abuse or alcoholism and illicit drug use (especially the use of cocaine) may also contribute to cerebral hemorrhages.

Diagnosis & Tests 

A cerebral hemorrhage is a medical emergency, which necessarily impacts how the diagnostic process will occur. Nevertheless, a doctor will need to assess the patient and figure out what part of the brain that has been affected. They will inquire about symptoms, medical history, and family history, and they will perform a physical examination and neurological examination. They will examine if the patient has slurred speech and if they have lost sensation in parts of their body.

Physicians will likely request a series of medical imaging studies such as computed tomography (CT) scan or a magnetic resonance imaging (MRI). In a CT scan, the patient will be scanned by a large machine that will produce X-rays of the brain. An MRI uses radio waves to produce images of the brain. Those tests and other like them can detect internal bleeding or masses of blood.

An eye examination might take place to see if the optic nerve is swollen. In very few cases, a lumbar puncture or spinal tap is performed. Spinal taps come with risks, so they are avoided when possible.

Chest X-rays, blood tests, clinical urine tests, and electrocardiograms may also be performed to fully investigate potential underlying causes.

Treatment & Therapy

Treatment is dependent upon the location and severity of the hemorrhage. Sometimes a surgery will be performed to try to prevent swelling and reduce pressure on the brain. Surgery may also be required to clip an aneurysm.

Medications like diuretics and anticonvulsants are used to try to reduce swelling and to prevent seizures. There are a number of drugs that can't be given to the patient, as they can make the hemorrhage worse. These drugs include anticoagulants and even aspirin.

Patients sometimes are given vitamin K intravenously or they might be given a blood transfusion of either platelets or blood with no platelets or cells. Sometimes the patient will be given an intravenous medication that will help blood to form clots such as prothrombrin complex concentrate.

Prevention & Prophylaxis

Preventative care relies on risk reduction via the adoption of habits that promote cardiovascular health. That includes quitting smoking or never starting to begin with and avoiding secondhand smoke.

Abstaining from drugs and alcohol and/or seeking treatment if one has a substance-related disorder are also preventative methods for cardiovascular problems that can lead directly or indirectly to cerebral hemorrhages.

Maintaining a healthy weight via regular exercise and a healthy diet will help reduce one's blood pressure and thus mitigate risk associated with hypertension. Protective helmets should be worn on construction sites, when competing in extreme or contact sports, and when riding motorcycles.

If the patient has had aneurysms previously, they can opt for surgery that can prevent hemorrhages. Individuals should also work with their health care providers to understand the risks involved in certain medications like anticoagulants and to take necessary precautions when treating other ailments.