Bleeding in or around the brain is called intracranial haemorrhage. The main types are intracerebral haemorrhage (into the brain tissue, a form of stroke), subarachnoid haemorrhage (into the fluid space around the brain, usually from a burst aneurysm), and subdural and extradural haematomas (between the brain and skull, usually after injury).
All are emergencies in which minutes matter. Outcome depends on the size and position of the bleed, how fast blood pressure and clotting are brought under control, and the cause. Survivors frequently need months of rehabilitation.
Symptoms
- Sudden, severe headache, often described as the worst ever (thunderclap headache)
- Weakness, numbness or drooping on one side of the body
- Slurred speech, or difficulty finding or understanding words
- Vomiting, neck stiffness and dislike of light
- Drowsiness, confusion or loss of consciousness
- A seizure in someone with no history of epilepsy
- Loss of vision or double vision, loss of balance
- In older people after a minor fall: gradually increasing headache, confusion or unsteadiness over days to weeks (chronic subdural haematoma)
Causes and risk factors
High blood pressure is the leading cause of bleeding into the brain tissue. Cerebral amyloid angiopathy, a fragility of vessels in older age, is the next most common. Others are ruptured aneurysms, arteriovenous malformations and cavernomas, blood thinning medicines, clotting disorders, bleeding into a tumour or into an area of ischaemic stroke, cocaine and amphetamine use, heavy alcohol intake and venous sinus thrombosis. Head injury causes subdural and extradural bleeds; in older people on anticoagulants even a trivial knock can be enough.
How it is diagnosed
- Non-contrast CT head: Shows fresh blood within minutes and is the first test in every case.
- CT angiography: Performed straight away to look for an aneurysm, a vascular malformation or a spot sign predicting further bleeding.
- Lumbar puncture: If CT is normal more than 6 hours after a thunderclap headache, spinal fluid is examined for blood breakdown products.
- MRI: Later, to look for an underlying tumour, cavernoma or signs of amyloid angiopathy.
- Catheter angiography: The most detailed vessel study, used when CT angiography is negative or to plan treatment.
- Clotting tests and platelet count: Guide urgent reversal of blood thinners.
Treatment options
- Stroke unit or neurocritical care: Close monitoring of consciousness, breathing, temperature and blood sugar.
- Rapid blood pressure lowering: Usually to a systolic of around 140 within the first hour, for intracerebral haemorrhage.
- Reversal of anticoagulation: Prothrombin complex with vitamin K for warfarin, idarucizumab for dabigatran, andexanet or prothrombin complex for factor Xa inhibitors.
- Securing an aneurysm: Endovascular coiling or surgical clipping, ideally within 24 to 72 hours, plus nimodipine for 21 days to reduce delayed vessel spasm.
- Surgery: Craniotomy or minimally invasive evacuation for selected accessible clots and cerebellar bleeds; burr holes for chronic subdural haematoma; an external drain for hydrocephalus.
- Treatment of vascular malformations: Surgery, embolisation or radiosurgery once the acute phase has passed.
- Rehabilitation: Physiotherapy, occupational therapy, speech therapy and neuropsychology, beginning in hospital and continuing for months.
When it is urgent
Every symptom listed above is an emergency. Call an ambulance at once for a sudden severe headache, new weakness, speech difficulty, a seizure or reduced consciousness. Do not drive yourself, do not take aspirin, and do not contemplate travelling: treatment must start at the nearest hospital with CT and neurosurgical access.
Travelling to Türkiye for treatment
There is no role for travel in the acute phase, and flying soon after a brain bleed is unsafe; ask your treating team when it is permitted. Later, a visit may be appropriate for planned treatment of an unruptured aneurysm, an arteriovenous malformation or a cavernoma found as the cause, which usually means 7 to 14 days, or for an inpatient neurorehabilitation programme of several weeks once you are stable. Bring all imaging on disc and your discharge summaries.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Is a brain bleed the same as a stroke?
Intracerebral and subarachnoid haemorrhage are types of stroke, about 15 percent of the total. Most strokes are caused by blockage, not bleeding.
Can I restart blood thinners afterwards?
Often, after a delay of some weeks, if your clot risk is high. It is an individual decision; options such as left atrial appendage closure exist for atrial fibrillation.
How much recovery can I expect?
Most improvement comes in the first 3 to 6 months, and gains continue for a year or more. It varies greatly with the size and site of the bleed.
Should my relatives be screened for aneurysms?
Screening is suggested when two or more first-degree relatives have had an aneurysm or subarachnoid haemorrhage, and in polycystic kidney disease.