rhage may result from trauma to the brain or from
the rupturing of a blood vessel (hemorrhagic
STROKE), and may occur within the tissues of the
brain, between the inside of the cranium (skull)
and the MENINGES(membranes that enclose and
protect the brain), or between the layers of the
meninges. Doctors designate the kind of bleeding
by its location, which also provides clues as to the
cause of the bleeding. A brain hematoma is a col-
lection of blood, though many people use the
terms hemorrhageand hematoma interchangeably
in referring to bleeding in the brain.
Suspected brain hemorrhage is a poten-
tially life-threatening emergency that
requires immediate medical evaluation
and treatment.Symptoms and Diagnostic PathSymptoms of brain hemorrhage are very much
the same regardless of the location of the bleeding.
They include
- severe HEADACHEthat may come on suddenly or
come and go - weakness or numbness (especially if only on
one side of the body) - difficulty forming words, using the right words,
or understanding what others are saying - NAUSEAand VOMITING
- irritability
- seizures
- fluctuations in consciousness and cognitive
function
The diagnostic path typically begins with a NEU-
ROLOGIC EXAMINATION and COMPUTED TOMOGRAPHY
(CT) SCANorMAGNETIC RESONANCE IMAGING(MRI)of
the head. These procedures can nearly always
confirm the diagnosis of brain hemorrhage as well
as pinpoint its location and provide information
for the neurologist to assess the severity of the
bleeding and potential extent of damage. Because
the standard of treatment for stroke that results
from a blood clot in a blood vessel is thrombolytic
medications to dissolve the clot, doctors conduct
these procedures with urgency so they can initiate
the appropriate treatment.Treatment Options and Outlook
Rapid treatment is essential to stop the bleeding
and relieve pressure within the brain. In many sit-
uations such treatment is emergency surgery to
repair the bleeding blood vessels and drain the
collected blood. The risk of dying from intracere-
bral hemorrhage (hemorrhagic stroke) is particu-
larly high because the bleeding is often extensive
and directly damages vital areas of the brain. The
extent of residual damage after successful treat-
ment depends on many factors and may not be234 The Nervous System
KINDS OF BRAIN HEMORRHAGEBrain Hemorrhage Location Likely Causes or Contributing Factors
epidural between the cranium and the dura mater (above the blunt trauma to the head
MENINGES) bleeding disorders
subdural between the dura mater and the arachnoid mater blunt trauma to the head
(the outermost and middle meninges)
subarachnoid between the arachnoid mater and the pia mater ruptured ANEURYSM
(the middle and innermost meninges) blunt trauma to the head
intracerebral within the tissues of the BRAIN HYPERTENSION
ATHEROSCLEROSIS
ruptured aneurysm
ruptured vascular malformation