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

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

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.

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?

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

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!

Did you have any kind of memory loss?

This gives me great joy and hope to read. My husband is currently in ICU with IVH very serious brain bleed. I am hoping he recovers and makes a story like yours! Prayers to you on this journey!

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.

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?????!!!

Plavix is also a dangerous drug. My mom had a brain bleed and because of that drug and the body's inability to clot because of it, we had to wait 8 days before they could do surgery. In the meantime she was losing the ability to speak and moblity. She wound up having 2 holes drilled and went thru hell and back but she's back at it at 91.

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 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.

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.

Don't mean to scare you but ,yes you can,my wife just died 8 -19 -17,it could de a lot of things.

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..

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.

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 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?

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