What Happens When a Brain Bleeds?

Question: 

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?

Answer: 

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 (illustrated below) 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.

Posted on BrainLine November 4, 2009

Jeffrey Bazarian

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.

Comments

My brother 32 years , no illness history or smoking, fall in interacranial hemorrhage at 23 July , followed by Conma grade 3 in 2 hrs Drs said nothing to be done , he passed away after 8 days at intensive care

My sister had emergency surgery for bleeding on the brain. She was having slight seizures. They put her on meds and her blood pressure was high. They got that lowered now too. She is also using her left arm now which she had no movement earlier. What is her prognoses ? She is leaving ICU today and going into a regular room. She fell weeks ago. No idea if she hit her head as she was alone. She is also on mega doses of OxyContin prescribed to her for years. She had issues with her left leg giving out on her and migraines in the recent past. She has very bad back issues too. Ty

Prepare for the worst. My husband was in icu on a ventilator as a result of a fall off a chair and hitting his head on metal door frame. He bled into the brain. They couldn't stop the bleeding. They took him off all sedation after 10 days but he never woke up and there was no response. We had to let him go. I feel for you, but it will depend on the extent of the bleed and if the are able to stop it. In my husbands case they couldn't.

My mum has recently had a few bleeds on the brain, she was put in an induced coma for 11 days, she didn't need surgery and are still trying to find the cause, she is awake and has full speech and movement, she had so many tests and scans and they can't find the cause, she has another Monday which I'm concerned about, they want to see under the bleeds, does this mean there could be a tumour

Mine too,she died after 25 hrs of a fall.I don't know whats worse,a long lingering illness or a sudden, unexpected death.She was very fit and active at 81 years old.We all thought she'd live to 150.

Yeah,my Mum too,3 weeks ago. Apparently warfarin and most other blood thinners can leave the brain very susesptable to bleeds with only a small knock to the head causing a bleed.Then the surgeons don't want to operate because the risks of uncontrollable bleeding.Some blood thinners can be countered to allow safe operation,warfarin unfortunately is not immediately counterable.

A similar thing happened to my mum 3 weeks ago,it was a fall and they couldn't operate because of the blood thinner medication.She slept for 25 hours then passed.She was 81 and very fit for her age.

My husband had a subdural hemotoma and while he wad in the ER he was giving a sedative which he shouldn't had. Sedative causes danger and complications.

My husband fell 6 wks ago and has blood on his brain. He can feed himself now (some) but I dress him,etc etc. Any advice on getting him to bathe? I have no professional help.
My dad fell down like 3-4 weeks ago... The doctor said a vein burst in his head which made it bleed... Throughout his time in the hospital he had mixed emotional patterns.. at first he was aggressive then he could not talk... The last week, this was a Saturday he began back to talk and was completely normal, laughing and singing... We even sang Adele..however he was waiting on an MRI before they could do the surgery and he was on a very long waiting list. I thought he would be okay... then Monday morning he died. The Dr said his brain began back to bleed. IMY with all my heart dad

When I was 2 years old. I climbed on top of a grandfather clock & pulled it on top of my head & gave me a traumatic brain injury. The neurologist said I had blood on the brain from tests done. It was up to my parents opt not for me not to have surgery at such a young age & the blood just dried up. My left hand is about 85% paralyzed. After so many years that pass, is there anything that can be done at all? 

My brother is in a correctional Institution, all in one day he's had many medical issues that has happened to him from inmates hes there with ...he was hit from behind severely 2times and was un- conciense when he then woke up (in medical in this jail)he had major dizziness and blurred vision and had bleeding from his ears and still bleeds from his ears everyday since this incident occurred..but the staff members released him with sever dizziness and blurred vision my question is : Medically what should have been done for him instead of releasing him with dizziness,blurred vision, and blood from his ears(what cautions and test)?Also, does dizziness and blurred vision happen due to the bleeding from his ears?Last, how long does a person usually have to get medical attention, when they are bleeding out their ears before it gets worse and leads to death?
There's this 4th grader that I really care about that bumped his head and it started bleeding so I searched up what happens and now I'm really scared

Hi my uncle has just had a brain bleed out of no were he was on blood thinner tables for he's hart he had some sort of shock they say this made it worse I just like to know if u think he will be ok he's only 57  and very fit 


My sister-in-law was an epileptic patient since she was a child.  She is in her early 30's and has recently had a baby.  While walking down some steps she slipped and hit her head and now she is experiencing random and chronic seizures.  She went to the ER in Utica and they sent her home and my brother has been corresponding with a specialist from Cooperstown since.  Is there anything they can do for her?  Will she be okay?  Is she going to have permanent brain damage from this?  What are some of the risks or expectations we should know about?  They're baby is less than 2 weeks old and she has had such severe seizures in the past she has an ECT device implanted in her body. 

I need a brief as my brother got brain hemorrhage last Monday. He is still on a ventilator and drs. are keeping him unconcious because of high blood pressure. Today they informed us that his blood pressure is returning to normal but CT scans show bleeding in brain. Can anyone who has been through this same condition tell me what's going on with him? i can't bear this pain please help me

Dr. Jeffrey B.  just wanted to let you know that you & every doctor / surgeon who have made neurology your life & passion, are all angel's here on earth with out wings. Thank you.

There aren't words to adequately express how awesome you are.

My 92 year old mother hit her head three nights ago. Today she is seeing people walking around in the house who aren't there. She refuses to go to the hospital and has no other symptoms. This has never happened before.
I was diagnosed with a brain aneurysm 3 years ago. After many tests and a short hospital stay, I still suffer from severe migraines and memory loss. I have been very lucky to have such amazing support from my family. As it was stated above ,our amazing dog Jenny plays a huge part in my recovery. We have our funny moments too, like when I briefly forget words in English and speak to my wife in German. That's always a trip. I wish a lot of love for anyone suffering from these awful conditions.

My son's Dad & I have been together for 20 years. He had a stroke while driving and had a head on collision into a phone pole. He suffered a brain bleed & frontal lobe damage. Hospitalized for a month - he contracted bacterial dbl pneumonia, then C diff from meds. Induced coma. When he woke, he was different. Before discharge his facial color looked awful. He couldn't breathe easily. He suffered pulmonary embolism (4 clots in the lungs). That was 6 years ago. He still suffers from memory loss, short and long. He forgets from minute to minute. His days can be good - our beloved dog ' Jack ' plays the most important role in his life. People learn to adjust because we have to. I've learned to be respectful and tolerant to his needs. He did not receive inpatient rehab. An occupational therapist came to us 2X week, they did word searches and crossword puzzles. Time, love and emotional support for him are still ongoing. He did come home to us, he is different but we have him. This is an ongoing journey and has changed all our lives.

my boyfriend is currently in ICU after getting stabbed in the head to the point where it reached his brain and caused it to bleed. The bleeding has stopped but the swelling is still there. From those that have experienced something like this with someone or themselves do you think he will be back to normal? when he talks hes doesn't make sense and he barely remembers anything.

My husband complained of neck pain and was vomiting. I took him to ER. He told the doctor he also had severe headache. CT scan showed blood on the brain. They did cerebral angiogram looking for aneurysm or cause of bleed. They found nothing that could cause a bleed. Doctor sent him home and he is scheduled for repeat CT scan in two weeks. He is still complaining of neck and head pain. He has never had high blood pressure. The doctor said the bleed is not active at this time.

My mom's friend fell backwards down the stairs yesterday night, luckily her kids noticed and called an ambulance, the she was taken to the hospital. They did a CT of her head and noticed her brain was bleeding down by the spine. As of now, the doctors have said the she won't live through tomorrow. I hope that she doesn't die, but if she does, I hope it's in her sleep. Rest in Piece, to one of the nicest people I know.

My moms brain was bleeding and by the time she got to the hospital she went put her self into a coma and the doctors said that there was nothing they could have done? Does anyone know if that's true? They said something about her mid brain?

My father is in hospital now (3 days) with a tube to come out now because it has drained all it can from his bleed to his brain from a fall 3 days ago. He is still in a what the Dr. call a slight coma, (not induced), because he kicks and twists, but will not or CAN NOT open his eyes. Now, Dr are moving him out of ICU or CC because they can do nothing more. I don't know what to feel about this, like all hope is gone.

My father was involved in an accident and had bleeding in his brain.He was on ventilator for 22 days.The doctors told me indirectly that his chances were very low. I remember myself feeling extremely afraid, I felt sick and vomited and did not sleep for first 2 days even though I am a 22 year old guy and I thought I was pretty tough.

Its very hard to go through this experience. When he woke up he was very aggressive and used to kick and punch everyone who came close and had to be restrained. We were blessed that he made a great recovery and although he can't work anymore but I am really glad that he is with us.

When the patient recovers from an injury like this he can never be his previous self but can still be 40-70% of his former self.

My Father went to the hospital on January 13, 2017 with this same issue. He was in and out of it, he had good and bad days. Doctors said healing time will depend on him. He passed away January 25, 2017. (Tear Drops) I LOVE YOU DADDY ALWAYS & FOREVER XOXO

I had a bleed on the left side of my brain a couple of weeks before Christmas. Had bad headaches which my GP first thought was due to some new medication, then sinus infection. Eventually went for an MRI and they found blood on my brain. Was admitted to hospital that day and transferred to a neurologic unit. Had surgery the next day. When I woke I could not speak and had forgotten things like bank PIN.

All came back over the following 3 weeks and feel fine now other than occasional light head.

Was told that bleed due to taking Warfarin.

My sister fell down stairs and went to hospital. They said she had a 2mm brain bleed. This was January 6th 2017. They said it would take a couple months to heal and sent her home. She passed away January 19, 2017 in her sleep

Hope your brother pulls thru! Mine wasn't so lucky....

My brother was hit in a freak accident. He hit his head on the concrete and it led to a brain bleed. He got hit June 6, 2016, and was put in a medically induced coma. The brain bleeding did not stop and a pressure tube was inverted in his brain and part of his skull was removed. They did ct scans every other day but the bleeding did not stop and eventually this led to his brain stem separating from the brain. He did wake up out of the coma and had to have restraints put on him to keep him from pulling out the iv's. When he woke up he would shout for help and say fuck! He would also try and climb out of bed but could not comprehend any questions or answer any commands. This happened with him while I was in the room with him, and he didn't recognize that I was even talking to him, like his comprehension skills were gone. He did yell out for an uncle who had passed on 25 years earlier, and also yelled Mom, like he needed her guidance but still couldn't recognize that she was there. The separation of the brain stem is what led to his death, 8 days later, the ventilator was removed from him and he had a DNR. I don't think I'll ever get over this freak death accident. He and our mother and I were very close, especially him and mom. He was an organ donor though and my ex- husband was a perfect match for his kidney, so he got to get off of dialysis. It's sad though that one had to die such a tragic death in order to save others, but God bless his soul for being such a blessing in disguise. He was only 40 by 3 months. I'm still trying to cope with his passing. I hope our story benefits someone else in a positive way. Thank you for letting me vent my brothers story of his death in remembrance. His passing was June 14, 2016. Chad Sanstra you will never be forsaken or forgotten! I love you till the ends of the earth and into infinity brother, forever and always!

my brother is still in icu but now they have installed a monitor in his brain by drilling through the skull. Ever since they did that the pressure in his brain has dropped excessively, which is a positive step.

My brother had an aneurysm that was bleeding from both ends, a coil was added only to one end of the leakage, was this done right?

My mum died from a bleed on the brain which was a direct result of warfarin

We recently lost our Aunt who was 86 due to a brain bleed. She was on a blood thinner at the time. The hospital said she wasn't going to make it and moved her into a nursing home. She passed 1 month after. 1 week ago we lost our mom to due the same thing. My mom was taking warfrin also and from the time she complained of a terrible headache to being in a coma in the ER was under 1 hr. Mom's was much worse. The scan showed the whole left hemisphere of her brain bleeding. There was swelling and they said it was inoperable. Sitting there watching her sister suffer she determined that she wanted DNR and to go as peacefully as possible if we ever had to make the decision. We didn't have to because she passed peacefully and pain-free 48 hrs after making it to the hospital. Within 2 1/2 months they were gone, both sisters. Mom was 71. The Drs have told us the the blood thinner combined with age was a contributing factor to my moms.

I just lost my husband 9/29/16 age 42 due to this. They also told me that if he woke up he would only know that I'm in the room with him and would be paralyzed. I sure miss the man I've been with for over 20 years seeing him lying in that bed for 5 days unable to breathe on his own has broken my heart. Having a massive stroke after 7 heart attacks and one stroke before this with high blood pressure, high cholesterol, diabetes and so many pills a day with pain .

My 69 year old brother fell off his bed while sleeping. He has been a diabetic since 1995. His two legs were amputated, he is on dialysis and has a lot of other serious issues.The day he fell he went about his buisness as if nothing happened, but then toward the early evening his wife noticed a bump on his forehead so he was taken to the hospital. They did a scan and found out he was bleeding so he is now in a hospital in ICU. Today he looks a bit better but he is unable to talk. Most of the comments I read don't mention this symptom. Is this natural to loose the ability to talk. Today is Saturday and the doctor has told his wife that on Monday they will do another scan and depending on the results he might do surgery on his brain.

I had brain surgery 3 years ago- I was 35 yrs. old. I had overgrown blood vessels which formed to the size of an eyeball and was leaking blood in my brain. That was causing a type of seizure which would suddenly put me thru a sudden blank stare, nonresponsive and loss of memory during that period of time. they kept increasing and lasted anywhere from a few minutes to the most was an hour, 7-10 times daily. I would walk into traffic. The tumor was right over my right temple which controls fear. I had become very gullible and since the surgery Im the complete opposite. I am not easily intimidated and have developed a very defensive attitude not to where i cause any trouble, but it throws people off. I mix up people's names all the damn time and I have a very hard time recognizing faces. My spelling is off at times, so I feel the need to Google a word for the correct spelling and sometimes meanings. I cant remember movies, so I have quite a few "new" movies to watch and a few I apparently loved lol. I too was experiencing the numbing of my hands and hard time making a fist as I would awake every morning. All my joints hurt and had a very hard time going up and down stairs. well, i was on Keppra and my doctor switched away from it and I don't feel that way anymore. Im a paralegal. i kinda have to think a lot, so I have tons of notes. I'm very easily distracted and have a hard time concentrating. I dont remember things, but as people remind me of something it slooooowly starts coming to me, then I remember with great details! It's strange. I remember things from my childhood. I'll remember first and last names...selective memory selects the weirdest thing at times. I struggle with too much info at once with too many details...my memory can't hold it for long and I'll need for it to be reiterated or summarized lol. I mean, I laugh at myself at times and I deal with it that way to where I dont feel sorry for myself and instead I'm open and talk about it to where it's ok to joke about things. For instance, my friends call me "Dory" from Finding Nemo since she was a fishy with bad memory, but i dont remember her lol. My memory is improving.... I'll remember things I try to remind myself about and now I find people asking me to remind them of things! and i do! so my memory has gotten much better, just don't invite me to the show to see a movie I'd like to see because most likely I already saw it lol I won't drive. My judgment is off. my walking judgment around a crowd of people is off and I'll cause a weird sudden stop or something...so yeah, cant do that behind the wheel. I tell people that I've be damned if I survive brain surgery then kill myself in a car accident lol. It's not easy, but its how you deal with it. You just gotta go with it and make the best of it. It gets better it just takes longer for some of us, but im just glad I'm alive and I didnt end up blind or handicap and i can still be independent and work and keep up with my house. stay positive. Sorry for blabbing away :o)

My mom had bleeding on the brain and recently died

I'm 60 yrs old female recently had a brain bleed going for scan in 2 weeks I'm worried that this is not soon enough should I be concerned?

I have mechanical valve in my heart had T.I.A  couple times over the years 

I slipped and fell on an icy drive way on my 27th birthday, I hit the back of my head causing the frontal left lobe to bleed, my swelling reached its max and was completely back down within 3 days. I was kickboxing at that time so I was in good shape. I was told that I healed well due to my low heart rate. I had 0 patience for about a month after, I wasn't so happy either (although I had nothing to be happy about really, considering the setbacks I was dealing with due to my injury) and I guess it was the effect it had on my personality, I didn't have any problem solving issues or anything with motor skills etc. 

Can you die from a brain bleed?!

My son has a concussion (hockey), his third, and is 7 months post now, still having terrible symptoms of headache and light sensitivity, fatigue. He is in grade 10 and feeling life slip by.  Been in bed last 4 weeks straight since trying to step him up gradually to more normal activity.  Can we be sure he doesn't have a bleed or do we need an image? 

Hello, it's been a year now.. my boyfriend has brain cancer and he's 27 yrs old (he'll be 28 by July 11) Today he's in the hospital coz his nose is bleeding and now he is unconscious. What does this mean? Please help me, i want to know everything about his condition. Thank you.

Hi my father is 60 years old and he had a brain hemorrhage before 4 years and after some treatment he was felt good. But recently he got another stroke and now he forget sometimes and even he cant recognize people for a moment. So what is reason behind it?

Hi, I have just had a cat scan that showed bleeding on the brain, because the initial symptoms i had that led me to get the scan (severe dizziness, numbness in legs, problems with vision) have cleared they have said its nothing to worry about. they said it was due to high blood pressure, which i have never had and usually test with lower than normal blood pressure) Should i be worried?? Should i get further tests??

Long story made short. My son 22 year of age, hit in head with metal baseball bat. Being told small bleeding in the brain. CT Scan show increase after each one. On day 3 and still slight increase. Trying to get him transferred Shands UF. In a little hospital now. Dr. declines to do another CT. Says no reason to. Trauma Dr. disagrees. My question is He is still experiencing lost words here and there. Has to think for a moment to complete a sentence. But eyes and etc are looking good. Head is in severe pain, feels like lots of pressure he( my son) explains. They are speaking of discharging him. I have concerns. As well as past 2 night heart rate dropping to 32 while at rest. When awaken it rises. Could heart rate dropping have anything to do with Bleed in brain. So my questions are: how long confusion or lost for words last usually? And heart rate dropping at rest, could this be from head injury.
 

~~About four month ago, I complained to my doctor of a loud noise in my left side of my skull for a long time, I insist in having a CT scan and finally she order to a CT be made, and the results shows that I have a blood clot of about a width of 11.4 millimeters and a length of about 5 inches, immediately she refer me to a neuro surgeon, and he told me that this hematoma will eventually disappear. I already had have three CT scans, and the clot still the same as when was discover, other than the noise I don’t have any symptoms, do I am in any risk? Can this clot be operated safely with no eminent risks?  

I have a friend who is is the Army. His daughter lives in South Africa with her Grandmother and just had a bad fall and now has some bleeding in the brain. She is needing a surgery, but they do not have enough money for the surgery at the moment. Are there any places that help in these circumstances?

I feel your pain my mom suffered a brain hemorhage the hospital refused to operate or relieve the pressure they asked us do we want to keep her on life support or hospice I said operate and will keep her on life support they refused so left us no choice I feel like I killed her putting her in hospice they don't feed you or give you liquids do how is this natural

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