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What Happens When a Brain Bleeds?
Jeffrey Bazarian, MD, BrainLine
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, 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 [17]
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?
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?
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!
can you die from it?
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!!
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
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
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??
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!
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.
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
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.
why does,nt neuron regenerate
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
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?
Thank you for the great explanation. Ahhh, my poor brain. It bled with no place to go...
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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