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 (155)

My mom was also on Plavix and was a fall risk but only had bleeding to the brain one time. We had gone to the Dr. to get a chest X-Ray. While the tech was preparing her, my mom fell in the room and hit her head. Since the Dr. knew she was a fall risk, there should have been 2 people in the room helping. She was rushed to the hospital and the CT scan found a small amount of bleeding on the left side of her brain. Another CT scan was done and Dr. said the blood was going away. They sent us home 2 days later. I asked to repeat the scan before we left the hospital and they said it wasn't necessary. A week later, while my mom was getting her stitches out, I asked the Dr. to redo the scan and again he said it wasn't necessary. Five weeks later, my mom died of intracranial hemorrhage to the left side of the brain. Does anyone think this is a malpractice?

Omg. Yes. There was a total lack of care & concern for your precious mom. How dare they not follow-up. It will not bring your mom back but in her honor send these SOB's a message loud & clear and seek justice for Mom. God Bless. So sorry for your loss.

Sorry to hear about it...

This is total irresponsibility of the concern Doctor and negligence. He/She should be fired and the licence should be suspended.

My wife and I went to her brothers to eat supper and I was telling her it seemed weird my mother hasn't called all day.  I sent her a text message, no response. Within the hour I get a call from her roommate saying my mother was on the floor passed out and would not respond but said she could move her hand.

When we got to the hospital the worst had happened -- she had been put on life support. When she first came in the doctors said half of her brain was basically dead. She still had a few movements of the shoulder and right arm. She would move when I told her "please fight through this with me I still need you." I looked up at her to kiss her forehead and her eyes were holding what looked like tears.

She didn't make it and later when I went to go get her stuff I checked her phone and there was a text saying "Joe I may need you come back I don't..." and that was the end of the message. She never sent it. I asked her roommate was her phone in her hand she said yes! That message was on draft at 4:00 am - just 2 hours after I left the night before. Her roommate found her around 5. My mother had laid on the floor for over 8 hrs with a hemorrhaging brain stroke and bleeding!

I was in shock thru that tragic two days I didn't ask the doctors the things I should have.  Please, somebody, tell me how she stayed alive for over 8 hours laying on the floor with her brain bleeding for the ambulance to find her unresponsive but passed away at the hospital? Why wasn't she able to make it if she had already lasted that long? She was 65 years old. Please, someone, I'm not dealing with this good at all. I need answers

Hello,
My mom has giant brain aneurysm since 18/8/2016 and recently she had congested 4th ventricle and cerebral hydrocephalus and edema .
Can anyone tell me what are the chances of survival.
She got fainted today and had a seizure

My brother while crossing the divider on the road, had a fall on the divider resulting in seviour right side head injury damaging 60% of the brain.There was profuse internal bleeding which according to Dr has 70% of the brain covered by blood.He was on Ecosprin like combination drug and Dr says because of this it is difficult to control the blood flow and the surgery is ruled out.He is in ICU and on medication with oxygen support and off and on ventilator.Please let me his chances of survival. It is very very urgent Please.

Hi,

I had very serious brain injury, broken skull, some parts, I was unconsciousness I think 5 days and started remember in 6 day. I lost my mind if I was awaking up they say, dont remember. For me helped recover good diet, no sugar, fabric food it makes good to brain and no stress, even like bad video games. At first I dint understand that I have bad health, it takes time. Going out with him might be good, talking, go lunch etc. but no bad food.
Take care!

Hi there my brother was admitted into hospital for some severe headaches and his blood pressure was 240 over 165 and its been two days later and he is booked into a second hospital where the doctors gave the report via a CT scan that he's got blood on the brain and that his brain moved but they cannot yet say what is the cause of this problem.... Does anyone have a expert opinion as to what the cause might be besides a tumor....? From a very concerned brother who is just expecting some peace of mind through expert medical advice

My grandmothers is 73, she fell on her head and we have been informed she had two bleeds on the brain..what is the likely outcome?

I'm watching your post waiting for the same answer, my gma has just had surgery today to treat 2 bleeds on either side of her brain, she came out of surgery about an hour ago, just wondering how long will she be in hospital for xx

So I just went to the hospital today and after reading this it scares me even more but they said no bleeding but I’m still in pain so I was just walking and my sister in law said that I just fell back and hit my head I was unconscious and when she woke me up I was lost didn’t know what happened I went to get a ct scan and everything was good they said I need to wear a heart monitor to see why I just fell but I’m scared for my head now

my uncle age 65 suffered two brain strokes and now doctors are saying his brain is bleeding. he was already on ventilator due to decreased functioning of lungs . can he be cured as he is on ventilator from 2 weeks

I had a brain bleed. I had no pain or headache. I had been to the doctor and was told I had an ear infection. Went home that night, went to get out of bed and everything starting spinning, was nauseous and losing my vision. Laid down on the floor, called 911 and passed out. I came to in the ICU with a drain in my brain and I had a tube down my throat to breath. Was in ICU for 2 weeks then in the hospital for 2 months. Thank you GOD, I survived with out any paralysis, just my balance is off, so I need to be very careful. Letting everyone know there wasn’t a pounding headache of any kind. After being home and back for my checkup, I have encephalitis and the Doctors want to put in a shunt. I’m waiting for my next CT scan before I have anything more done. What is giving me problems are my eyes, so I’m making an appointment with an eye doctor. Oh BTW, they never found where the bleed came from.

I was diagnosed with a CSF leak after CT MRI w/o contrast of the brain & spine. Also had 2 brain bleeds (found by test). Had 2 failed blood patches. Then I️ went to a different hospital, had a blood patch in IR and had to lay flat for 24 hours! Still home recouping! Is it normal to have sharp pains in head (not constant) 2 weeks after blood patch?

I'm going through the same thing right now. I would like to know what you found out?

In the same condition now. Had a serve headache like never before and had a ctscan. I was airlifted to a hospital and they are running more tests. Second day for me with an angiogram scheduled later today.

my 19 year old son was in a car accident in April of 2017 and no MRI was ever done. He had a concussion, whip lash, bulged discs and injured leg. Has suffered with much more severe migraines and odd headaches like a baseball bat hitting the back of his head. We decided to go to ER for the next bad migraine he would have to try to expediate a neurology appt that was still way off in the future. ER doc gave him Toradol injection. 8 hrs. later my son had a brain bleed and a stroke . Was told in the ER that he may have a horrible rebound migraine. We called PCP and was seen 2 days later. PCP ordered Mri, which was done 1 and half weeks later which showed brain bleed with dried blood surrounding the pons. Was admitted to ICU neuroscience unit for 4 days and released was told to live life cautiously. All the other scans could not tell where the bleed came from because of all the dried blood that was 2 weeks old (when stroke occured). He begins therapy because stroke caused weakness on his right side . They couldn't tell us much other than to have another MRI with contrast in 3 months and maybe they could have a better idea of his problem. I'm scarred if it is a recurrent bleed, which they said is possible. Has anyone ever heard of this happening from Toradol. The nurse did say he was giving him more than the usual dose because he "is a big guy". My son is 6'5 and 265 pounds.

I accidentally fall on the floor and hit my head. I have laceration on my right eyebrow but it is now already treated. What I am worrying is that I have blood draining from my mouth, is this because my brain is bleeding?

My fiancé went to the hospital Monday and he didn't know he had water on the brain from him falling and passing out. Now he is in a coma but he is breathing on his own. Does this mean death or what? I'm so scared for him and myself. I hear so many stories. I'm in Virginia and he's all the way in Kentucky.

My friend was perfectly healthy until yesterday evening he felt severe headache followed by vomitting and nausea. On CT scan of head it was identified he has a blood leakage in his head. But however doctors aren't able to identify yet why and where precisely the blood is leaking. They drilled his top of the head and removed clot or liquid to ease pressure on this brain. Today they have done MRI and still they didnt reach out to us. What could be the cause? Any similar situations? He is just 29 year old and perfectly a healthy person.

My girlfriend at about lunchtime felt a massive headache followed by lots of vomiting called an ambulance to hospital ct scan MRI only to be told you have a bleed on the brain. Blood work was just taken, a heart ultrasound. Hopefully, I will still be here when the doctor brings back the result of blood works in the meantime my friend is suffering from throbbing headaches will update when I know more. regards

My son in law was 34. He was at work and went to his truck to get a band aid. Somehow he fell and hit his head. When he got to the hospital they said he had a brain bleed but they stopped it. Within a few hours they checked again and he had another bleed. He never woke up. My daughter choose to donated his organs. I just don't understand.

My 58 year old sister was experiencing headaches for two days. She started chemo a month ago and everyone thought she was finally starting to feel the impact of that medication. Unfortunately, late on the second day, she had a major brain bleed and was found on her bedroom floor, unresponsive and barely, if at all, breathing (reflexive breathing?). Her heart stopped on the way to the hospital in the ambulance. Restarted her heart, but remained unresponsive. Within hours, we had to make the decision to stop breathing for her as she was described to us as "brain dead". I asked the doctor if she was dead, and he responded by saying "Yes". She was taken to ICU and it was in that situation that we decided to stop the assisted breathing...her heart stopped beating about 30 minutes later. What a very sad experience - she was 58. Cause? Doctor believed it was a weak point in a vein that she probably had since the day she was born and it just took this many years to burst. I hope she felt nothing more than the headaches we knew about prior to her dropping to the floor on that second day. Doctor told us that she "felt no pain" since this situation probably took her immediately...he did say it was massive and severe, having pushed her brain into one side of her skull and the situation had entered her brain stem area. Sounds horrible, but I believe that she had to have gone very, very quickly. Tough and horrible situation.

My daughter 43 had a meningioma tumor removed. The dr said he had to give her 2 units of blood. She pulled through the surgery but 2 months later she is gone. She had a Brain Bleed just like your sister. She was unresponsive at home the paramedics shocked her twice her heart started beating but she was Brain Dead. It happened so quickly I don’t know if she felt anything but she was suffering from cancer and Bells Palsy. We had them pull the plug because I did not want to see her with that tube in her mouth. She died within seconds. Feb 25,2018

In so sorry about your daughter. My brother had the same type of tumor. It was removed on September 11 of last year. He was in rehab learning to walk again and was diagnosed with the brain bleed on Feb 1st. He had the surgery to repair. Was intubated for 2 weeks after. Now he doesn't talk. He can't do anything. He sleeps about 23 hours a day. I don't know what's going to happen now. I just mainly wanted to say I'm sorry about your daughter

My dad fell and hit his head..went to hospital with a minor brain bleed that seemed stable..stable enough that they released him 24 hours later..he was home from the hospital for 4 hours and then found unresponsive on couch barely breathing ..taken back to hospital only to discover bleed bled out of control and pushed brain aside declaring him brain dead ...he passed the next morning ..I really don't understand how the hospital released him so soon without doing another cats on before he left?????!!!

That's terrible, I am so sorry for your loss. We are going through something similar. I think you should take legal action against the hospital

So sorry for your loss. my youngest daughter had stroke 8/15. She was half brain dead at the hospital, fully brain dead on 18th. We pulled the plug that night They said she died of a black bleed. She was 52.

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 husband was 55 years old and had the same thing happen to him on july 9th and was in a coma seemed to be doing well and had a second bleed on july 23rd 2017 and passed away, which was my birthday. I'm so sorry for your loss..

My friend only 15 had the same thing was in a coma seem to be doing fine but died a week after

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

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

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.

I worked hellthcare with the elderly. I would recommend using a shower bench. It has a seat and the legs extend outside and inside the tub. If you don't have a shower wand then I would use a water picture. I would not use the tub itself. Too much danger of falling. With a bench he could sit on the edge and then swing his legs in the tub while scootng over. Hope this helps you. I would also recommend calling your insurance company to see if they would support help or the county .You may qualify for free help if you are low income.

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

I had a bicycle accident two weeks ago and had bleeding on the brain. Most times the blood reabsorbs and goes away. Mine did and I am home now resting and healing.

Did you have any kind of memory loss?

I did, for many years and i still do however I'm starting to remember things better and also whenever I see something that will remind me of whatever happened at a certain situation it will cause me to remember certain things and so that's basically how I remember most stuff but I do have memory problems but not as bad as they were about 10 years ago

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.

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.

Same thing happened to my father-in-law. We forced him to go to the hospital on day 3 after fall. A CT scan showed bleeding of the brain. We are now waiting on a consult from a neurosurgeon.

Hi Giselle, what was the outcome of your father-in-law? My Dad is in the hospital, being sent there today for bleeding on the brain. They suspect it's been bleeding for 3 days by the CTI. He just went through radiation and he has 4th stage cancer. Thanks in advance!

Pages

Add new comment

CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.