From the Guidelines
Physical symptoms consistent with a brain bleed include sudden severe headache, nausea and vomiting, seizures, sudden weakness or numbness, difficulty speaking or understanding speech, vision problems, loss of balance or coordination, confusion, altered mental status, and loss of consciousness. These symptoms typically appear suddenly and worsen rapidly because blood accumulating in or around the brain creates pressure on brain tissue, disrupting normal function. Some patients may also experience neck stiffness (especially with subarachnoid hemorrhage), sensitivity to light, and in severe cases, coma. The severity and combination of symptoms depend on the location and size of the bleeding, as noted in the guidelines for the management of spontaneous intracerebral hemorrhage 1. Key symptoms to look out for include:
- Sudden severe headache often described as the "worst headache of your life"
- Nausea and vomiting
- Seizures
- Sudden weakness or numbness (particularly on one side of the body)
- Difficulty speaking or understanding speech
- Vision problems
- Loss of balance or coordination
- Confusion
- Altered mental status
- Loss of consciousness If you experience these symptoms, seek emergency medical attention immediately as brain bleeds are life-threatening medical emergencies requiring rapid diagnosis through brain imaging and prompt treatment to reduce pressure on the brain and address the underlying cause, as emphasized in the guidelines for the management of spontaneous intracerebral hemorrhage in adults 2, 3, 4. Delays in treatment can lead to permanent brain damage or death. It is essential to prioritize these symptoms and seek immediate medical help to minimize morbidity, mortality, and improve quality of life.
From the Research
Physical Symptoms of Brain Bleed
The physical symptoms consistent with a brain bleed can vary depending on the location and severity of the hemorrhage. Some common symptoms include:
- Sudden and severe headache
- Nausea and vomiting
- Confusion and disorientation
- Weakness or numbness in the face, arm, or leg
- Difficulty speaking or understanding speech
- Vision changes, such as double vision or loss of vision
- Seizures
- Loss of balance or coordination
Diagnosis and Management
According to 5, the presentation of patients with intracerebral hemorrhage (ICH) is often similar to other stroke patients and requires rapid recognition, imaging, and evaluation. The diagnosis of ICH is typically made using noncontrast CT examination of the brain, which discloses the anatomic location of the bleeding 6.
Causes and Risk Factors
Trauma is a common cause of intracranial hemorrhage, while spontaneous intraparenchymal hemorrhage is often associated with hypertension when found in deep locations such as the basal ganglia, pons, or caudate nucleus 6. Small vessel diseases, such as deep perforator arteriopathy and cerebral amyloid angiopathy, are also common causes of spontaneous non-traumatic ICH 7.
Treatment and Management
Treatment of brain bleed typically begins in the emergency department and focuses on correction of abnormal coagulopathies, blood pressure reduction, emergent treatment of intracranial hypertension, and recognition of those in need of urgent surgical decompression 5. Medications such as nicardipine and labetalol may be used to manage elevated blood pressures in patients with ICH and subarachnoid hemorrhage 8.
Emergency Department Management
In the emergency department, patients with traumatic brain injuries should be managed using a systematic approach focused on the avoidance of secondary injury, including hypotension, hypoxia, and hypoglycaemia 9. Urgent neuroimaging is recommended for patients with severe TBI, followed by consultation with a neurosurgeon and transfer to an intensive care unit.