A brain bleed, also known as a hemorrhagic stroke or intracerebral hemorrhage, is a life-threatening condition. It occurs when a blood vessel ruptures and bleeds into the brain tissue. This causes damage to the surrounding brain cells and increased pressure in the skull. Understanding your chances of surviving a brain bleed and the factors that impact prognosis can help you make informed medical decisions.
What causes a brain bleed?
There are several potential causes of a brain bleed:
- Uncontrolled high blood pressure – This can weaken blood vessel walls over time, causing rupture.
- Aneurysms – Ballooning or weak spots in blood vessel walls can burst.
- Head trauma – Injuries to the head can damage vessels and cause bleeding.
- Brain tumors – Abnormal tissue growth can impair vascular integrity.
- Amyloid angiopathy – A buildup of amyloid proteins can make vessels brittle.
- Drug use – Illicit drugs like cocaine can raise blood pressure and lead to bleeding.
- Blood thinners – Anticoagulant medications increase bleeding risk.
- Vascular malformations – Abnormal vessel development since birth increases risk.
Identifying and managing high blood pressure, avoiding head trauma, and controlling other vascular risk factors can help prevent brain bleeds in some cases.
What are the symptoms of a brain bleed?
Symptoms of a brain bleed usually come on suddenly and require emergency care. They include:
- Sudden, severe headache
- Nausea and vomiting
- Confusion and change in consciousness
- Seizures
- Drowsiness or loss of consciousness
- Difficulty speaking or understanding speech
- Vision changes or loss of vision
- Difficulty walking or loss of balance/coordination
- Numbness or weakness on one side of the body
The sooner a brain bleed is diagnosed and treated, the better the chances of survival and recovery.
What is the overall mortality rate for a brain bleed?
The overall mortality rate for hemorrhagic stroke is around 40%, meaning almost 4 in 10 cases are fatal. However, the chances of death depend heavily on:
- Bleed location – Bleeds that occur deep in brain tissue or in the cerebellum are more likely to be deadly.
- Bleed size – Large volume bleeds have higher mortality rates.
- Age – Older individuals have higher risk of death.
- Other medical issues – Co-existing health conditions increase mortality.
- Time to treatment – Faster treatment can prevent rebleeding and reduce mortality.
Smaller bleeds detected and treated quickly in otherwise healthy younger people have mortality rates under 20%. Larger bleeds in older adults or those with chronic medical issues can have mortality over 60%.
What factors affect chances of survival?
The key factors impacting chances of surviving a brain bleed include:
Bleed location
Bleeding into deep brain structures like the basal ganglia, brainstem, and cerebellum is more likely to be fatal compared to lobar bleeds in the cerebrum. This is because deep structures control vital functions like breathing, heart rate, and consciousness.
Bleed size
Small bleeds under 30mL have a lower mortality rate than larger bleeds over 60mL. Larger bleeds cause more pressure and damage to surrounding tissue.
| Bleed Size | Mortality Rate |
|---|---|
| Less than 30mL | 25% |
| 30-60mL | 35% |
| Over 60mL | 55% |
Age
Older individuals have higher mortality from brain bleeds, likely due to reduced brain plasticity and the presence of other age-related diseases. The mortality rate ranges from:
- Younger than 45: Around 20%
- 45-70 years old: Around 35%
- Over 70: Around 60%
Other medical conditions
Co-existing health issues like heart disease, diabetes, kidney dysfunction, and immunocompromised states increase the risk of death with a brain bleed.
Time to treatment
Patients who have brain bleeds diagnosed and surgically treated within the first 4 hours have lower mortality rates. Quick treatment can stop rebleeding and reduce pressure on the brain.
How is a brain bleed treated?
Treatment focuses on stabilizing the patient, stopping the bleed, reducing brain swelling, and managing complications. Steps include:
- Intensive monitoring – In an ICU setting to observe consciousness, vital signs, and neurological status.
- Medications – To control blood pressure, reduce swelling, prevent seizures, and manage pain/discomfort.
- Surgery – Either craniotomy to remove the hematoma or less invasive endovascular coiling/stenting to seal the ruptured vessel.
- External ventricular drain – A drain to relieve pressure from cerebrospinal fluid buildup.
- Rehabilitation – Physical, occupational, and speech therapy to help regain function.
Treatment should start as soon as possible after the bleed’s onset. The faster the blood is removed and pressure relieved, the better the outcome.
What disabilities can result from a brain bleed?
Disabilities after a brain bleed depend on the damage severity and area affected. They may include:
- Paralysis – Inability to move parts of the body (hemiplegia).
- Altered cognition – Issues with memory, attention, problem solving and reasoning.
- Speech/language deficits – Difficulty producing or understanding speech.
- Vision changes -Blurry vision, double vision, or loss of visual fields.
- Ataxia -Loss of balance and coordination.
- Behavior changes – Impulsiveness, mood swings, and loss of social appropriateness.
With rehabilitation, some disabilities may improve over the first year after the bleed. However, permanent impairment is common depending on severity.
What is the outlook for recovery and long-term prognosis?
The prognosis after a brain bleed depends on:
- How quickly it was treated – Faster treatment leads to better recovery.
- The amount of damage – Extensive bleeding causes more permanent effects.
- The location – Bleeds in speech/language centers lead to greater communication disabilities.
- Age and prior health – Younger and healthier people have better healing.
- Access to rehabilitation – More aggressive therapy improves outcomes.
While many patients have significant disabilities after a brain bleed, recovery can continue to improve for up to a year. With extensive rehab, some are able to regain independent function. However, effects like paralysis, altered speech, and cognitive changes often persist long-term.
Around 50% of survivors have moderate to severe impairment that requires assistance with activities of daily living. Understanding the prognosis and possible disabilities can help patients and families plan for potential long-term needs.
What are the chances of having another brain bleed?
The chances of having another brain bleed depend on the cause:
- Bleeds caused by trauma are less likely to recur if the person avoids future head injuries.
- Bleeds caused by aneurysms have a high recurrence risk if the aneurysm is not repaired.
- Bleeds caused by high blood pressure have a recurrence risk of around 5% per year if blood pressure is not well controlled.
Careful management of underlying vascular risk factors like hypertension and follow up imaging to detect new aneurysms or vascular malformations are important to prevent another devastating bleed.
What emergency steps should be taken if someone has a brain bleed?
If you suspect someone is having a brain bleed, call 911 or seek emergency care immediately. Timely treatment is critical. While waiting for help:
- Have the person lie still – Do not move them unless absolutely necessary.
- Note any seizure activity – Prevent injury but do not restrain movements.
- Maintain open airway – Roll them on their side if vomiting.
- Apply oxygen if available – Through a mask or nasal cannula.
- Monitor vitals – Watch for changes in pulse, breathing rate, and blood pressure.
- Provide reassurance – Keep them as calm as possible until help arrives.
With rapid recognition and transport to a facility that provides neurocritical care, the best chance of survival and recovery from this devastating event can be achieved.
Conclusion
Brain bleeds are very serious, often fatal events. However, the chances of surviving can be improved through timely diagnosis and treatment. Factors like the size and location of the bleed, patient age and health, and access to surgical intervention and rehabilitation all impact prognosis.
While survival is possible, brain bleeds often cause long-term impairments. Understanding the typical outcomes can help patients and families cope in the aftermath. With good fortune and proper care, recovery may continue to improve for months to years after the initial event.