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 (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. Reviewed March 27, 2019.

Comments (266)

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Hello my friend is in the hospital in ICU, she suffered a massive heart attack and cardiac arrest, shes 39! The drs said her Brain is still swollen and its been 7 days, we are all hoping shes ok and pulls through, anyone have anything or experience any thing close to this would be helpful. Im looking for direct answer no sugar coating please i can take it.

If your brain was bleeding and it stopped but you clearly could see where the blood on the brain was does it just go away or do they have to remove the blood.

My dad passed away mon afternoon after having a terrible headache he was took into hospital had a ct scan which showed he had a minor bleed to the brain but was fine the hospital kept him in overnight so they could do another ct scan in morning but at 9.30 that morning while doing they’re checks he was unresponsive and unconscious they then noticed he had another massive bleed to brain which killed him , why did the hospital have to do another scan why did they not operate that night when they saw the minor bleed to the brain ?

My Dad died of a
brain hemmorage that came out of absolutely nowhere 3 years ago. He suffered the worst kind of headache Father's Day morning.
Of course,we know now that that was the beginning of the end.
He died a horrible death a few days later. It was a horrible awful bad week,month,so forth so on.
I miss him bad.
Whoever you are,if you are dealing with now,I am sorry.
Keep the good memories alive,
Keep active in your life as much as you can,
and write down every little good memory,every detail,.this will help you later.
Chocolate is good right now,and you will find that you have memorized where the ice cream is at your local store.
Even years later,remember your dad happily.

Thank you so much for this wonderful comment. My dad has survived his bleed, but we are not sure whether he will survive long-term or recover. Your comment made me find joy in the pain and uncertainty. Thank you x

I am sitting in my car outside the ER reading your post.thank you.

Hi I had a rta in nov and then surgery for a bleed on the brain 19th January followed by two further surgeries for infection and leaking csf fluid , last Friday I was c.t scanned finding a small bleed again , the hospital have said it’s small so no need for treatment but I’m worried it will get worse not better

I am a 29 year old healthy woman they have told me. But for the past week I have been having a headache that resembles more of head pressure. It also comes with dizziness, rapid heart rate and and chest pain. When I am up and moving it seems to be worse than before sometimes. Never had any head injuries that I can recall. I have been to the ER twice. Two different ones. Had a head CT at both and both came back fine. Also experience some weakness or fatigue throughout the day. Should Inbe worries about a brain bleed or aneurisms if both CT scans came back clear?

Please have a neurologist do a MRI /MRA to make sure yo dont have an AVM (malformed artery vein connection) which can rupture and bleed. CTs dont always pick them up, or better yet a cerebroarteriogram which show all of rhe vessels. Most ER docs aren't that skilled. I would say a neurologist or neuro surgeon would be best to start with. My hubby. now is physically disabled,and dependent, following a rupture that nearly killed him.

Nearly 30 yrs. ago, I received a CHI/TBI due to being in an auto accident. I was 21.When the police told my mom, she called the hospital and an ER nurse, told her that there was swelling and bleeding on the brain. What kind of medications and procedures, would they have used in the ER back then, decades ago.

Hope u r a better dr than the one's I come in contact with. This is the 2nd time I was released with a brain injury. Confused and agitated and 3 day's later I can't stand up for long and when I tried to sweep it kept smelling like blood in my nose. Also keep feeling pressure in my sinus area

Can anyone who has experience with a loved one going through this after prescribed blood thinners?

My brother is on Eliquis currently in ICU on vent with a brain bleed. Did you receive info on your question?

Yes my dad had 4 blood thinners after a heart surgery last week and two days later he is in the hospital with a brain bleed stroke.

what happens after? can you be fully functional after recovery?

Bilateral convexity subdural hematomas, larger on the left. The left subdural hematoma measures 9 mm in thickness and exerts mass effect on the adjacent brain parenchyma. The right subdural hematoma measures 3 mm. There is 2 to 3 mm of rightward midline shift. No downward herniation. The ventricular size is normal. Diffusion abnormality and susceptibility associated with blood products. this what they said about my MRI with contras, this showed up two months after my car crash, should I be worried since it happen so late after my accident? none of the other ct showed this before and I had 4 ct before this one. should I be worried

Hi Yolanda, did you ever find a resolution to this? My dad was/is under a similar situation, where he was diagnosed with a subdural hematoma months after a car collision. He took steroids for 2 weeks and his subdural hematoma was greatly diminished in size, his midline shift has gone from 7mm to 2mm, but the slow brain-bleed has continued, so I'm curious if you're also struggling with the same. Hopefully you've been able to heal completely, and if so, I'd be curious to know what was done in your situation ~ thanks.

I was told, that I have bleeding vessels in the back of my brain. I have to see a neurosurgeon. What will he do?

I have a small bleed in the brain which is causing me headaches i have had them for about 8 weeks i have to see a nerosurgeon what will he do

My son 30yrs ago had a very bad fracture of the skull. Over a period of years he has suffered two brain bleeds. He can’t smell anything. Now drinks to much. Is that a worry

Sir my mamiji fell from a bike. She has got severe head injury. Her surgery was done after 48 hours. In surgery, her front forehead bones were removed and kept in stomach so that brain can expand. After a day, in her CT scan it shows there is bleeding inside the brain and platelets less. She is unconsciousness from five days and able to breath much on ventilator. I want to know what are the chances of her survival. I am waiting for reply as she is in hospital right now fighting for life in PGI Chandigarh.

I am praying for your family in this time of turmoil, may God give you peace, wisdom & understanding.♡

My sister had a brain bleed and was unconscious for a 6 hours waking a few times, she was moved to a neurology hospital where on arrival she became responsive answering the Drs questions. She had one brain scan, and the neuro team were going to give her another. Within 10 minutes of being responsive she started having seizures. She was operated on and found that another bleed had occurred and her brain had been too badly damaged and she died later on. Is this normal?

My sister had a tumor removed from her pituitary gland. The tumor was bigger than thought, and she had a brain bleed, fluid and her brain was swelling. Now because of the location of the blood, she can't open her eyes. She has a drain in and will put in a shunt later this week. I know every one is different and our bodies are different and react different. But how long will it take for this blood to be drained so she can open her eyes?

My 2 month old grandaughter has been admitted to the hospital my daughter said she stopped breathing after a bottle and nappy change she phoned for an abulance while her husband gave cpr the paramedics came and put a tube down her throat she started breathing again she was given a scan of her brain to rule out meningitis but they were told she has a bilateral brain bleed how has this happened why has this happened

What are the symptoms?

I was admitted to Royal London hospital on Monday with a suspected bleed on the brain. They wanted to admit me for a Lumbar puncture and MRI. As the royal london is 2 hours from my home I asked if i could be transferred to a hospital near my home. They agreed, discharged me and said that I should take a letter they gave me to my GP for the referral to the hospital nearer my home. The hospital have my referral and it was sent as urgent. My scan is now scheduled for anything up to 4 weeks. Surely this is too long for a suspected brain bleed? Any advice would be appreciated.

Going through this as we speak. My mother in law was sent to emergency by her doctor over two weeks ago with a suspected stroke. They did not do a cat scan and said she was just old and confused and sent her home. Two weeks later now her doctor made a ‘scheduled’ CT scan, they sent her straight to ER and she is currently (while I type this) having surgery to drain the old blood from two weeks ago. Slow brain bleed She most likely will have permanent damage from pressure and lack of octogenarian to parts of her brain.

Don’t take no for an answer. Keep going to emergency until the do a scan. It’s not worth waiting. If it’s a suspected bleed...the sooner you catch it, the better.

We don't live in the same city, or I would have pushed for the scan two weeks ago that’s why we came now! Hope you get help.

Hi. I was in a car crash over 6 months ago I had a minor bleed on the brain. I was told I was fine and sent home. I’ve been suffering with severe headaches ever since is this a sign of blood clotting on the brain? Severe headaches and every now and then a weird pain in the back of my left leg ?

My mom had a brain hemorrhage and a stroke and for some reason had an infection that the hospital could not have her find they eventually pretty much kicked her out of the hospital afyer 2 months into a nursing home and within two weeks she had passed away in my opinion I think she had sepsis and they never tested her for it could I be right on that topic

My mother passed away and I already talk to the doctor about how she passed away. They said she was brain dead by bleeding in the head but idk how that can occur they didn't say if she fell or want do they even know what exactly happen because she was staying with her bf that is abusive. I need answers it really hurts I feel so lost

My heart hurts with you. I feel sad about your loss and especially about how little you know about how your mother died.
Personally, I would feel lost most of the time if I didn't have someone strong and kind who is with me and helping me. hymnsradio has given me so many answers. I don't know if it might help?

I have concussion now for the 6 th time due to rugby can't remember anything from the match is it possibly bleeding on the brain

I have a very good friend that I found out had a recent sudden brain bleed, was in icu and not expected to make it, found out that he did but can not see or speak but is aware of his surrounding s, don't think I should go see him, don't know anything about him except what another friend of ours tells me that this guy's wife tells him I would like to see him eventually, but have also heard that he may end up in a nursing home, kiss of death, how can I be a friend to him and find out if his wife is telling the truth to our friends? ?

Honey, it's not for you to find out. Perhaps the family is protecting their own, and themselves, it's a difficult time for each of you. Every processes differently. Be
understanding, patient, kind.

Go see him for yourself
. Life

Go see him for yourself. Life is too short for questions!!!!!!!!

mom fell, split her head open, required 6 staples, had a concussion and wound up with a brain bleed. as the blood receeded she started having 2 incidents of multiple strokes. What damage did the brain bleed cause???

Husband had a fall, head wound, stitches and two small brain bleeds.
What precautions should he take during recovery

Please can someone help me, my father has had his second craniotomy surgery in one month. He has a spontaneous bleeding from his brain, no one knows the cause? In 3 days he has lost 300 mls of fluid from his brain that’s in a drain attached to his head. He has confusion, disoriented. He’s 80 y/o. He had a stroke as well. He is in icu and I’m his daughter and I don’t feel I’m getting straight answers about his condition. Today has been day 5 and he’s still bleeding into the drain. Can anyone tell me when this will stop.

I am so very sorry you went through this. I hope he made it out okay. Sending prayers. God bless!

We are in a similar situation with my sister in law no straight answers. I found your comment on this website I’m doing research possibly ask about the bloodwork look at the MRI pictures or whatever they are Doing to help him and why. We pray for all of us

My husband fell down stairs from top to bottom .went to the hospital no scan offerd 2 weeks later he died from a catastrophic brain hemorrhage .if he had a scan would he still be alive

Not necessarily. And the brain damage may have been so bad it isn’t what either of you would have wanted. You can still get answers about his condition and i would if I were you.

OR they could’ve caught the bleed in time had they did the scan.

My girlfriend had a stroke on one side of her brain and on the other had anurisum rupture at the same time. They removed a large part of her skull from her left side. They put it back on 3 months later. I never spoke to any of the Doctors her family took care of that.
But now I have her living with me and I don't know what to do for her.
She calls things like a bra she called it a strip. She does this a lot. Will this get better or is for life.

My son had this after a traumatic head injury and it is called Expressive Aphasia. He had had it for 10 years now and it seems better but it still happens now and then but not often. The thing is he doesn't realize he said the wrong word. Google it and it could help you. Good luck.

It’s called aphasia. My son had it after a motorcycle accident. It is the most difficult thing in the world. It does get better with therapy.

I was told it can take up to two years for improvements I had two bleeds in minor vessels n head and was lucky I was in hos and hubby beside me when my anerisim burst and caused a stroke I’m confusing some words six months on but DONT care I’m still hear and able to walk and talk my sis had only a stroke and because of the slight time delay with ambulance picking her up she’s paalyzed down one side I was lucky I. Hos for 4 weeks

So glad to hear you're doing well. Hopefully you continue to make progress!!!

I fell and ended up with two minor brain bleeds. The only thing I have experienced is it seems my ear is plugged. So my hearing is off. Can that happen? There is no bleeding from my ears.