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What Happens When a Brain Bleeds?

Comments [32]

Jeffrey Bazarian, MD, BrainLine

Ask the Expert: What Happens When a Brain Bleeds?
 

I've been hearing about bleeding in the brain after a TBI. Can you explain how this happens and why it's so dangerous? What exactly is a subdural hematoma?

 

Let's start with the basics. A hematoma is a tumor-like collection of blood, usually clotted, located outside a blood vessel. The subdural space is located between the dura mater (the outermost, toughest, and most fibrous of the three membranes covering the brain and spinal cord) and the arachnoid membrane (the middle of these three membranes). The epidural space is located on or outside the dura mater.

Now, to answer your question, a subdural hematoma is basically bleeding into the space between the brain cover (dura mater) and the brain itself. More specifically, there are blood vessels running through the brain and in the spaces between the outside of the brain and the inside of the skull. During a brain injury, any of these vessels can tear and bleed. Ruptured vessels running in the subdural space — typically veins — cause subdural hematomas. Ruptured vessels running through the epidural space — typically arteries — cause epidural hematomas. Both types of bleeding take up space in the skull and in so doing squeeze down on the brain. Because arteries are under pressure, epidural hematomas leak quickly and compress the brain rapidly while subdural hematomas leak much more slowly.

Because the brain is enclosed within the rigid skull, it gets compressed by this leaking blood. With enough bleeding, the brain gets compressed so much that oxygen-rich blood is prevented from flowing into the brain tissue. This lack of oxygen causes additional brain swelling. This brain swelling, added to the blood leaking from the torn vessel, forces the brain down through the small hole at the base of the skull called the foramen magnum. The parts of the brain that come in direct contact with the bone around this opening get so compressed that they stop working. Because these brain areas control breathing and heart rate, death can result.

Getting to the hospital quickly is the best way to diagnose and treat this bleeding, which usually requires surgery to remove the blood and relieve the pressure on the brain.

 

Click here to go to About Ask the Expert.

Jeffrey Bazarian, MDJeffrey Bazarian, MD, Dr. Bazarian is an emergency physician with a strong research interest in traumatic brain injury. He is associate professor of Emergency Medicine, Neurology, and Neurosurgery at the Center for Neural Development and Disease, University of Rochester Medical Center.


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Comments [32]

My step dad and I were home alone I was 5.  He went to shovel to roof fell off and came in the house with blood coming out of his ears, nose and mouth, i think i went to the neighbors house and they called the hospital and they had him their quickly but he passed.   All this time latter i know have seizures due to epilepsy and sometimes fall, it is scary, some times i don't even have my head checked out, oh well

Apr 3rd, 2014 4:33pm

My sister had an aneurisn on Father's Day of 2013. She is a miracle in all of her family's eyes. I cried cause she is so strong and such a survivor too. She also lost her husband to cancer shortly thereafter. I am just so proud of her, she recently got her license. She was soo thrilled. I was wondering if the headaches that she has will ever go away or is it going to stay with her for the rest of her life??

Mar 27th, 2014 7:38pm

Does a patient w negative CT scan and LP results showed xanthochromia, erthocytes and high protien and  shows bilateral drop foot (hours after lp) likely have hemotoma or traumatic tap?

Mar 26th, 2014 4:34pm

Could u live when your brain bleeds

Mar 24th, 2014 9:04pm

I slipped and fell a month ago getting in my truck. I hit the back of my head on the corner of the truck cab. I sat there and watched the car next to me go from gray to almost black. Since then I am have trouble with dizzyness. If I stay in one position for very long and move I get dizzy to the point I have to hold on to some or fall.

Mar 14th, 2014 5:16pm

I dont get why some people survive and some die frome a bleed in there brain

Mar 9th, 2014 4:42am

My 26 year old little brother was attacked and beaten badly, a CT scan has shown a 7mm bleed to the left side of the brain by the left ear, the hospital have said they won't operate as it hasn't ruptured, but if it ruptures I fear he won't survive to tell the tale.

Oct 28th, 2013 2:52pm

TRAUMATIC BRAIN INJURY-A CAREGIVER'S STORY I brought a child into this world. I loved and nurtured this child. I taught her right from wrong. I strongly influenced her morals and values. I guided her as I watched her grow. She grew to be a beautiful young lady with a kind, caring heart and a beautiful soul. I loved her dearly. I prayed that she had learned what I gave up my life to teach her. I allowed her to shine as I took a step back with love and pride knowing I raised her well. Then tragedy strikes and in one moment in time it is taken all away from me. They call it traumatic brain injury. She lays lifeless in a coma, hooked up to machines that are giving her life. The doctors have saved her life but can give me no answers as to what the future will be for my child, the child that I have loved so dearly and watched her grow to be the beautiful young lady that she was, with a kind, caring heart and a beautiful soul, the young lady that has been taken from me who lays lifeless in a coma. The doctors and nurses took me down a road, the rebirth of my daughter. I have watched the rebirth of this child from the moment the fingers on her left hand started to wiggle and then her left eye started to open. I didn't know it then but she was being reborn before my eyes. It now is the second time I am watching my child grow. But this time it is different from the first time as she grew from an infant. This time the unknowing and the unexpected, the hours and hours of research involved to gain knowledge and strength so I can be the best mother I can be to help my daughter on her journey. It is hard to tell you the deep feeling of love I have for this child. It is an unexplainable feeling. A feeling that unless you go through it, it would be unexpectable to feel or know. There is an overpowering feeling of love and total devotion, so much stronger now then the first time I watched her grow from birth. It is a love that circumferences every fiber of my being; a feeling of pride that can bring me to tears. Like when I heard her say ma-ma for the first time after 4 months of silence. Or when she turned her head or moved her arm or leg for the first time, or even when she learned how to swallow a bit of Italian ice for the first time. Or when she asked me with such innocence and wonderment, what is a pretzel or ma-ma what is a pear? The bewilderment I felt as she ate it having to accept that she honestly didn't know what it was. I just took for granted that she knew but she didn't know. She didn't know anything. She lived in the moment, no past, and no thoughts of the future. I needed to reteach her all about life and how her life experiences made her the person she was today. As her memory came back she was astonished about how she knew certain things about life and herself. She wonders if I am her mommy and is amazed at the miracle of life and that she was born. It is now coming up on the second anniversary of that moment in time when my daughter was reborn; watching her grow a second time brings such a fulfillment of hope and pride. It is with this overpowering feeling that I know with all the sacrifices I have made along the way to devote myself and my life to the rebirth of my daughter; being her eyes and ears when she could not speak or hear, learning how to be a great caregiver to her, and instinctively, strongly advocating for her, finding the resources that are out there to help my daughter, putting her therapies in place and watching her conquer, achieve and advance to new levels and climbing those mountains with unexplainable strength, courage and determination to overcome her deficits to the best of her abilities. I know that this is the greatest accomplishment of my life and worth every sacrifice I have made along the way and will go on making as I help my daughter continue to be the heroine of her life and not the victim. Excerpt from my journal, written September 29, 2008

Oct 18th, 2013 11:18am

I was with my brother when he passed away from a glioblastoma two years ago. He was breathing but when I turned the light on I saw blood from his nose onto his pillow and grey lines on his face. The ambulance workers worked on him for over an hour/ Can you tell me what probably happened to have him still breathing, the blood on the pillow and the lines on his face. Had he passed away when I found him or was he still alive??

Sep 15th, 2013 3:01am

My mum was admitted to icu, she thought she had a headache from dehydration within a few hours started vomiting. My dad took her to the hospital thinking that she may have heat stroke from walking around in the sun all day. On arrival to the hospital they gave her a ct scan they diagnosed her with a subdural haematoma "no accident, no fall, no bumps of the head" not one doctor can explain how or why? and we have been through the last few wks to figure out if she may have had a accident, mum is a spring chicken and very active and fit. Can someone explain how, why? Frustrated and worried daughter

Jul 29th, 2013 4:40am

my nephew had an accident on 29th may 2013, by bike colliding with bike coming from other side. when police brought him hospital and informed me of accident, he was already unconscious. after doing CT scan found bleeds in right side of brain. we rushed to guwahati GNRC hospital for surgery which took us around 9 hours to reach. after reaching he was given ventilation and operation done within 1 hour. its already been 1 month he is still unconscious,but we were given assurance that he will recover and we also hoping that he will open eye either today or tomorrow..my pray to GOD...

Jun 28th, 2013 12:44am

My niece had a stroke in her sleep and never woke up. when they got her to the hospital we were told she had blood on her brain in found out it was ITP. Its been a week and she is still comatose. She had to have two brain surgery done not to mention in the midst of all of it she had 3 stroke, 3 seizures, 3anersym had to have over 20+ blood transfusion, her lungs collapse and there now saying she have a flu. They said she wasn\'t going to make it and if she do she will be partially brain dead. Although she haven\'t woken up, We witness legs movement from both legs,(tighten up to like she trying to stretch)flinch when the doctor pinch her foot & mouth movement (cough)& murmur her mouth(like she trying to talk), eye movement,(shed tears)and when the nurses turned lights on her eyes tighten up as if its to bright. Sunday she halfway open her right eye, and we told the doctor the next day in he said No, she didn\'t when I and some of the nurses witness it just as well. She is on the ventilator however it show her breathe a little on the monitor. The doctor said its all reflex but I believe in God report in I believe he bringing her out of it. Miracle Child

Jun 25th, 2013 6:05pm

My 25 year old son suffered a severe brain injury four years ago. After being in a coma for three weeks he emerged as a vegetable and didn't talk or walk for six months. That was the most difficult time in our lives. Four years later he is living independently although doesn't have a job or a relationship but things do improve. You have to remain hopeful and take each day at a time.

Jun 19th, 2013 7:10pm

Have there ever been any studies done on babies born with hematomas? My oldest daughter had two fair sized ones on opposing sides of the skull, we experienced a lot of behavioural issues with her for years and years until she was dx'd with four concomittant disorders. Would the hematomas have contributed to this dx?

Jun 13th, 2013 4:32pm

My heart goes out to everyone with a loved one who is in ICU, it's a dreadful time for the family. You must understand every brain injury is different, no two are the same. Talk to the consultant in charge of the person, they will be honest and straight with you. But don't loose heart! The brain takes a very long time to recover, if it can. Therapy, patience and endless love and work is required. Bless you all.

Jun 13th, 2013 4:28pm

My sister was at a skate park with a friend. Her friend dared her to do down a concrete ramp on top of a wheelie bin.. So she did and she fell off. They airlifted her to a hospital hours away and they found she has a broken neck and bleeding on the brain.. But yesterday they found a second bleed! She hasn't woken up and I'm soo worried and scared :'( I don't know what to do.. Will she make it?

Apr 22nd, 2013 7:31pm

I was in a car accident and i was not concious when taken to the hospital. I had no physical injuries and the hospital could not understand why i would not wake up. It took three MRI"s before they spotted a drop of blood from my brain. I am now suffering with numbness on my left hand and cold feet and thighs and slurring in my speech with memory loss. It seems like it is not getting any better. Does this problem worsen as you age? The accident was 5 1/2 years ago.What happens on the long run?

Jan 3rd, 2013 12:11am

If you was shoved and hit inthe eye and got a blackeye and fell on sofa and head hit wall in back and was supposely had blleding on brain or brain injury can you be released within 30hrs of occurrance and at hospital playing on cellphone and wat not? How true do you think this really is?

Oct 24th, 2012 2:50am

Yes, my poor brain has been through so much. I have three subdural hematomas and on the right side of my head. The first is located on the top of my head, the next is located in the middle and the last hematoma is located on the bottom of my skull, and I am really worried. My head feels like a presure cooker and my head really hurts and feels like it is just going to burst. I was in tears last night just wondering what am I going to do about this problem. I do have a TBI from an old tramatic injury that I had when I was a kid and really scary!

Oct 17th, 2012 8:23pm

can you die from it?

Jun 11th, 2012 10:05am

My friend Ben seems to have bleeding ear lobes and hair folicles is this due to brain bleeding (could this be due the rest of his friends being incredibly irritating, excluding me of course?) This is causing him also to slur words when speaking and causing inflamitary pain to everyone around him! no one seems to be able to give any medical attention! please reply!!

Feb 23rd, 2012 7:00am

Hi there Dr. Bazarian. My 20yr old step son was in a horrible accident. He was hit at a dead stop by another car from behind at about 70mph. He has "several bleeds" is what we are told. He is semi conscensious... a lot of swelling in his face, lips, neck... he did have an emergancy surgery to remove his spleen the night of the accident... he has been inICU ever since... He is NOT on a breathing tube... just a feeding tube and oxygen.. When will things seem to be getting better... or, how long until we are out of the clear with these brain bleeds and the swelling??? The doctors at the hospital just don't seem to have the answers right now and it's frustrating thats all. He isn't speaking very well when he is able to answer A question... he is not able to move very well... Im just trying to understand just how serious this is

Feb 15th, 2012 4:43pm

MY BROTHER ACCIDENT AT RIGHT SIDE BRAIN A SMALL BLOOD CLOTTED(DURING INTERNALL BLEEDING IN BRAIN),DOCTER TRATED BUT RIGHT HALF BODY DOES NOT WORK,WHAT I DO?DOCTER SAY BROTHER REQUIRE LONG TIME FOR FULLY FIT

Jan 17th, 2012 7:50am

hiya,. colin here. could you please explain. what happerns . when you? that is me? has a carotid artiory dissection??? thank you for your time. as this condition is unnusuall??

Jan 5th, 2012 3:48pm

one of mah friend's head got injured approx 3 months ago. These days he was having sever pain in half of his head. Doctor says one of his vein is bleeding and he'll have to go through an operation. what kind of operation he'll have? n how long he'll take to recover from that operation? is their any kinda probability of complexions? plz help me out!

Nov 30th, 2011 5:51am

hi my partner was in a bad car crash and when he arrived at the hosptail they said he had bleeding on the brain, how badly can this affect his personality.

Sep 9th, 2011 5:17am

my Dad suffers from acute stroke and brain bleeding interventricular from increase blood pressure. how can we know the bleeding stop, can any thing stop it? ranooshmmm@yahoo.com

Jul 31st, 2011 6:13pm

My uncle was rushed to a hospital yesterday for an intracranial hemorrhage. He had bilateral pulmonary emboli so was put on coumadin and they said one of the clots broke loose and traveled to his brain causing it to bleed. His heart is beating, he is breathing on his own, but outlook doesnt look good. is this something that happens often? i am guessing there was so much bleeding because of being on the coumadin and blood thinners.

Jul 5th, 2011 10:03am

why does,nt neuron regenerate

Nov 23rd, 2010 11:07am

I MEt with accident on Apr 2006 after that I have been taking Valporic Acid Tablets when in between I stopped tablets I Fainted and once it was just like epileptic attack but then I Recovered MRI,Brain analysis (Psylogical tests)were normal but for how long I have be on these medicines (Encorate Chrono). Please reply on akash_ds@hotmail.com , I am looking for case studies and not any medical advice

Sep 8th, 2010 10:14am

I sustained a brain injury from a assault. Why was blood coming out of my left ear and nose? Does that mean my brain was bleeding?

Jun 24th, 2010 11:18am

Thank you for the great explanation. Ahhh, my poor brain. It bled with no place to go...

Nov 5th, 2009 12:02pm


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