Diagnosing Brain Hemorrhage

A brain hemorrhage occurs when blood vessels that feed the brain and its surrounding tissues are damaged, leaking blood into the surrounding tissue or cavities. An intracerebral hemorrhage is when the blood leaks directly into the brain, and a subarachnoid hemorrhage is when it leaks into the arachnoid space between the brain and its surrounding membrane. Brain hemorrhages, even small ones, are serious and potentially life threatening because of the damage they can cause to the brain via infarct and pressure.

Some patients fully recover from a hemorrhage, others suffer long-term complications. For the approximately 50% who make it to the hospital, the way to minimize the effect of the hemorrhage is to obtain a prompt and accurate diagnosis. Doctors use basic examinations and various scanning technologies to confirm a hemorrhage and diagnose its location and severity, particularly magnetic resonance imaging (MRI) and computed tomography (CT).

Spontaneous hemorrhage occurs in approximately 40,000 people a year in the United States and accounts for 10-20 percent of all strokes (Medscape). The most common reason for nontraumatic bleeding within the brain is hypertension, and most subarachnoid hemorrhages are caused by aneurysms, which can be due to hypertension or congenital vessel malformations, particularly berry aneurysms. The first part of diagnosing a brain hemorrhage is to consider the patient’s history, but more importantly the symptoms, which include: seizures; sudden severe headache; weakness, numbness, or tingling in the limbs; sudden nausea and vomiting; loss of motor skills and coordination; sudden vision changes; and loss of consciousness.

To determine whether the brain is functioning properly, doctors may conduct simple eye observations to note pupil size and eye movement, a basic physical exam can allow them to check for muscle pain and stiffness,  and a neurological exam can determine if the patient’s mental state is altered. If the symptoms and examinations indicate a neurological deficit, the doctor then has to visually confirm the hemorrhage.

If a vessel in the brain has hemorrhaged or is hemorrhaging, the blood will be visible on the brain scans. Though not always necessary, versions of the MRI and CT that use angiography (MRA and CTA), the infusion of a dye into the blood vessels through an IV, can also be done to pinpoint the affected vessels. Both are considered minimally invasive.

There is also cerebral angiography, which relies on contrast dye and X-ray to visualize the blood vessels in the brain. In addition, transcranial Doppler ultrasound, a technology using sound waves to image the anatomy, may be used to detect vasospasms, a potential complication of hemorrhage that can lead to stroke.

Each patient requires a different approach to confirm the location of a bleed and ensure adequate follow-up and treatment because each hemorrhage varies according to its location, extent, and resulting severity.