Brain Hemorrhage: Causes, Symptoms, and Emergency Treatment

A brain hemorrhage — bleeding within or around the brain — is one of the most dangerous forms of stroke, accounting for approximately 20% of all strokes in India. Unlike ischemic stroke (where a clot blocks blood flow), hemorrhagic stroke occurs when a blood vessel ruptures, causing blood to accumulate and compress surrounding brain tissue. Every minute counts — the larger the bleed, the more brain tissue is destroyed.

Types of Brain Hemorrhage

Intracerebral hemorrhage (ICH): Bleeding directly within the brain tissue. The most common type. Caused by: chronically uncontrolled high blood pressure (the leading cause in India) — weakens small blood vessels over years until they rupture; cerebral amyloid angiopathy (deposition of protein in blood vessel walls — common in the elderly); arteriovenous malformation (AVM) — an abnormal tangle of blood vessels present from birth; bleeding disorders or anticoagulant medication overdose.

Subarachnoid hemorrhage (SAH): Bleeding into the space between the brain and its outer covering. The hallmark symptom is a sudden, catastrophic headache — the "thunderclap headache" — described as the worst headache of one's life, reaching maximum intensity within seconds. Most commonly caused by rupture of a cerebral aneurysm (a balloon-like weak spot in a brain artery wall). SAH is a neurosurgical emergency with mortality of 30–50% even with treatment.

Subdural and extradural haematoma: Bleeding between the brain and skull, typically following head trauma.

Warning Symptoms

Sudden very severe headache (thunderclap); sudden weakness or numbness on one side; sudden difficulty speaking or understanding speech; sudden vision loss or double vision; sudden loss of consciousness or seizure; neck stiffness with headache (SAH sign). Call 108 immediately — do not wait to see if symptoms improve.

Treatment

ICH: control blood pressure; reverse any anticoagulants; surgical evacuation of large haematomas compressing the brain. SAH: secure the ruptured aneurysm (surgical clipping or endovascular coiling) within 24–48 hours to prevent re-bleeding; prevent vasospasm (delayed narrowing of arteries). Intensive care monitoring is essential. For stroke and brain emergency care: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.