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. Reviewed March 27, 2019.

Comments (244)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

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!

Thanks for sharing this , I lost my only brother 28th Dec 2019.fell down going up stairs and hit his head. Heartbreaking and uncomprehendable . Bless you

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

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.

My husband died December 6, 2017! Don't feel I will ever recover! I miss him so. He got up at six to make coffee, he didn't want to wake me. He fell in kitchen putting on his pants. He said he didn't hurt himself!! He was on Coumadin for years. Four days later he had a headache and I took him to the ER. Subdural hematoma!! They thicken the blood with vitamin k and plasma to operate. If he had been on any other blood thinner they couldn't have reversed it to operate in time. I had five weeks with him unconscious but once he squeezed my hand and looked at me. If only more people were educated on blood thinners!!!!!!!!

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 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?

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)

I feel your story. I was a brain aneurysm survivor from 2010. Mine ruptured and I had a bleeding in the brain for more than 5 minutes. I was in the ICU for more than 4 weeks and I had a stroke within a year and two mini stroke after that. But I was fortunate to have the best Neurosurgeon who knew what to do how to stop my bleeding to avoid my from becoming handicapped for life. What I had was a short term memory lapse for the first 6 months but the reading and crossword puzzles helped me get it back and the short bursts of exercises and short walks. I feel your story and everyone who is going through and had gone through it. Any brain disease in any family is a hard thing to deal with and I know because I am the 5th member in our family generation who had gone through having brain aneurysm and thankfully all survived with the grace of God.

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!

My mom had bleeding on the brain and recently died

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.

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?!

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 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

My father was taking couminden 'a blood thinner' at the time of his fall. He was a moderately healthy 83 year old. He fell in his back yard and hit his head (left side above his eye) on a metal tool box. He was immediately taken to the hospital emergency councious the intire time. CT scan showed a brain hemerage. Apromxetely 10 hours lator he slipped into a coma. After hearing the Drs diagnosis the family opted for him to go naterally. I found it quite odd that they didn't even have him on a saline drip, For his breathing and heart were fine til the end. Dad was a fighter, a U.S. Marine, I often wonder if the right decision was made. A week later hospis administered the potient concoction that took him from us. I say do all you can do. I Miss you Dad!😇

So sorry to hear about your brother. Life is so delicate....too many times we don't realise this. I hope your family are coming to terms with this terrible loss. My thoughts are with you xx

Yesterday Monday, October 13, 2015 I had to bring my father in this hospital. Dr. told us that he has a big blood clot inside his left side brain and getting bigger reaching for the right side of the brain. He just fell asleep with loud snoring and could not open his eyes or move his right leg and hand. Could not answer using any words but tried to shake his head. Currently under life support, what they call ventilator. His breathing rate is improving but still has no sense. And now in the icu I found my father's both legs are moving sometimes. But they are telling me that the signal to move his legs is not coming from his brain. Its just muscle movement. They refused to go any further even to think about a surgery. May be because of his age is over 70 now. And when I tried to force them to do something, they told me to pray for him and thats all what we can do... Another surgeon told me that even if they took a chance, probability of his recovery is less than 20%... Feeling ice-cold heart inside just to imagine watching him die... Anyone can suggest anything?

My nephew fell whilst out drunk in the early hours of Saturday morning, he was rushed to Hope Hospital and has had a CT scan which has shown a bleed in his brain!!! Can this bleed rectify itself or will they have to operate?? He is really suffering with headaches which are causing him tremendous pain...... Any advice will be welcome

My sister had a shunt fitted which worked too well, it removed all the fluid from around her brain. This caused her to have a large bleed. They have operated and drained the bleed but a CT scan shows the bleed has not stopped. She is also on Warfarin to stop blood clots. They have had to lower the dose until the bleed stops. What will they do next to stop the bleed? 

my wife had a aneurysm and is in a coma for about a month.

she opens her eyes and responds or commands to close her eyes .

she squeezed my hands sometimes on command.   How do I get her out of this

coma. I feel depressed and helpless about her condition .

My brother fell last Tuesday and hit the back of his head. Complained later of a headache and there was some vomiting but would not get it checked out. Thursday morning, still vomiting and had terrible headache. Seizures started at 9am, ambulance was called. He was was unresponsive and put on a respirator. He died at 12:25pm. MRI showed significant brain bleed which caused his heart to stop.

HI 

I would like to ask for an opinion. A mature man was punched several times in the head and had been to hospital.Simple exam were done and released home. Had swallowing and bruising around right hand side eye and face. He had headaches and was talking strange. Couple weeks later he had big headache, admitted to hospital and they found  bleeding on the brain. The bleeding was on the same side he was punched. Genetic test were done twice, not linked with bleed. Gentlemen does not have any medical problems nor any facts for that. I had mix opinions from the doctors so if some one can tell me is this from assault or what Thank you 

My cousin died on thursday due to having bleeding on the brain he was in a bit of a fight 5 weeks before and got knocked to the floor he started having headaches just over a week later we told him to go to the doctors but he shook it of and said he was fine do you think this could be related to him being knocked to the floor? Please i need peoples advice

Hello my husband had an accident 6 months ago he had surgey remove blood clot. SAH contision of his front lob temprol lob  also diffuse axonal injury

My brother in law has fallen 3 times resulting in ER visits, all with brain bleeds. However, this last fall was a direct hit to the back of the head, causing bleeding to the sides and the front of the brain.  A drain was placed in his skull to drain the bleeding.  He is in a medical induced coma.  The CT scans show no change.  Drs. indicate the need to wait 72 hrs. before determining brain function, etc.  Could he have permanent brain damage?  He has been an addict a huge part of his life.  The first 2 falls were attributed to alcohol. However, this 3rd one, has no explanation.  Please share your expertise and knowledge.  Thank you kindly.  MJB

My Dad is 88-yrs old and has dementia right now he's in a care home .He has to be 24/7 watched .He has fallen a lot in the last 6 to 7 yrs. The doctors have given him CT scan and there's bleeding on his brain. The plan on doing other one to see how much the bleeding is spreading or if there's more. This is really hard I'm the only who has to make all the decisions for him.

Just Pray from bottom of your heart. This is the only Medi. 

My father recently passed away, he went into hospital because he was forgetful and ended up being diagnosed with delirium... After weeks in hospital with slight improvement every day he ended up having a clot in his lungs which they say was due to staying in the bed for too long. After 5 weeks he ended up having a brain bleed from the thinners used for the clot and this left him in a vegative state. His food and water were taken out and was left to die...he died after 9 days...devastated... He was such a strong man, I still don't understand how this all happened and really didn't get many answers from Dr's. Heartbreaking to see my father slowly die from what??.... Dehydration??!!!

Do little bleeds need surgery?

Not all brain bleeds end in severe mental illnesses or death. When I was born I had a brain bleed behind my eye. I had to receive a special treatment that opened my pupil so that they could see behind my eye. I am now 12 years old. I'm fine. 

My cousin just passed away he was only 12 years old boy He had an accident with head injures and internal injures He died because bleeding in the brain he had the accident on friday n died on wednesday which is very sad

my friend had a brain bleed and I am worried because he is aware of people and sometimes tries to speak one word at a time, but he brother wants to stop feeding him and just let him die, it has only been three weeks and he is getting better everyday, I cannot understand how a hospital can allow this, since the man is getting better each day and he does not have a DNR.  everyone is praying for him and today he asked for water and prayers.  How can one allow this, he is even moving his legs and hands.  everyone who knows him is upset.  please pray. for all persons in this situation.  How can a doctor and a brother make such a decision when the patient is getting better daily??? very upset in California

i was admitted to the icu for 21 days with a tbi, they had to drill holes into my skull to drain the bleeding in my head... 

My nephew had a spinal tap for Meningitis and is now blacking out and has seizures and pain shooting down his left arm. The hospital released him stating was due to an event, but no major events. He is 6'6 and the doctor missed the first time. Please help my 19 year old nephew. He was fine till this happened.

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