A hematoma is a tumor-like collection of blood located outside a blood vessel. In the brain haematomas can form in the subdural space and the epidural space. The subdural space is located between the dura mater (the outermost 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.
A subdural hematoma is basically bleeding into the space between the brain cover (dura mater) and the brain itself. 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, such as in a car accident where there is a blow to the head, any of these vessels can tear and bleed. Ruptured vessels running in the subdural space cause subdural hematomas. A rupture of the blood vessels running through the epidural space cause epidural hematomas. Both types of bleeding take up space in the skull and in so doing squeeze down on the brain. Epidural hematomas bleed quickly and compress the brain rapidly while subdural hematomas bleed much more slowly. Both types of bleeding can have serious implications.
As the brain is enclosed within the skull, when bleeding occurs there is no space for the blood to drain into. The blood therefore builds up and causes compression and pressure. If the bleeding continues, the brain gets compressed (squashed) 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. This are of the brain controls breathing and heart rate so the effects of this can be critical and sometimes death can result.
Getting immediate medical treatment form a Doctor at hospital is very important. The earlier the bleeding to the brian is diagnosed and treated the quicker the pressure on the brain is relied. Treatment involves removing the blood, sometimes through surgery, and stopping any further bleeding.
How does Bleeding in the Brain occur?
There are several risk factors and causes of brain hemorrhages. The most common include:
- Aneurysm. Aweakening in the blood vessell wall that bleeds inot the brain. Can lead to a stroke.
- Brain tumours
- Head trauma. Head Injury is the most common cause of bleeding in the brain for those under 50. This can be - as a result of a car accident, fall, or blow to the head in a sports injury or assault.
- High blood pressure. This chronic condition can, over a long period of time, weaken blood vessel walls.
- Untreated high blood pressure is a major preventable cause of brain hemorrhages. High blood pressure should always be carefully monitored by a Doctor and appropriate diet and lifestyle changes implemented to reduce the risk.
- Blood or bleeding disorders. Hemophilia and sickle cell anemia can both contribute to decreased levels of blood platelets.
- Liver disease. This condition is associated with increased bleeding in general.
If someone is suffering bleeding to the brain what symptoms will they have?
The symptoms of a brain hemorrhage can vary. They depend on the location of the bleeding, the severity of the bleeding, and the amount of tissue affected. Symptoms may develop suddenly or over time. They may progressively worsen or suddenly appear. If you exhibit any of the following symptoms, you may have a brain hemorrhage. This is a life-threatening condition, and you should seek medical attention immediately. The symptoms include:
- a sudden severe headache
- seizures/ fits
- weakness in an arm or leg
- nausea or vomiting
- decreased alertness, lethargy, confusion
- blurred or altered vision, or a sensation that the room is spinning or out of focus
- tingling, numbness or pins and needles particularly in the fingers or toes
- difficulty speaking
- loss of fine motor skills, such as hand tremors
- loss of balance or co-ordination sometimes affecting the ability to walk
- an abnormal sense of taste
- in more severe cases loss of consciousness
How is bleeding in the brain treated?
The Doctor, usually a Neurologist, will first needs to assess which part of the brain the bleeding is coming from. Doctors may run a variety of imaging tests, such as a CT scan, which can reveal internal bleeding or blood accumulation, or an MRI. This may be undertaken by a Neuro-radiologist. A neurological examination or eye examination, can show swelling of the optic nerve, may also be performed. Blood tests and a lumbar puncture may also be needed.
Treatment for bleeding in the brain depends on the location, cause, and extent of the hemorrhage. A shunt may be inserted to drain the blood. Surgery may be needed to alleviate swelling and prevent bleeding. This will be undertaken by a Neuro-surgeon. Certain medications may also be prescribed. These include painkillers, corticosteroids or diuretics to reduce swelling, and anticonvulsants to control seizures.
Can people recover from bleeding in the brain?
How well a patient responds to a brain hemorrhage depends on the size of the hemorrhage and the amount of swelling. Some patients recover completely. Possible complications include stroke, loss of brain function, or side effects from medications or treatments. Death is possible, and may occur despite prompt medical treatment.
Bleeding in the Brain and medical negligence compensation
If there was an avoidable delay in medical treatment being provided this may give risk to a claim for medical negligence compensation. An example of medical negligence would be a patient attending at the GP surgery complaining of a severe headache, confusion, lack of sensation in the arms and no co-ordination. The GP fails to examine the patient and diagnoses a migraine. The following day, the patient's symptoms have not improved and he collapses. He is taken to hospital where he receives a lumbar puncture test and MRI scan which shows he has a severe bleed to the brain.
Immediate surgery is undertaken to relieve the swelling but unfortunately the patient now has permanent weakness in his right side which affects his ability to walk and he is no longer able to work as a electrician. These are symptoms that potentially indicate a brain hemorrhage and the Doctor must take steps through a full examination of the patient and taking an appropriate history, to rule out this possible diagnosis. If the examination does not rule out a diagnosis of bleeding to the brain, a referral should be made to hospital for further immediate investigations.
If a GP fails to recognise the symptoms and passes them off as a migraine, this may result in there being a delay before the brain hemorrhage is diagnosed. A delay of even a few hours can sometimes be critical. If medical evidence indicates an earlier referral would have led to the patient making a full recovery following surgery, the patient may be entitled to compensation for injury affecting the right hand side and loss of earnings for the fact he is no longer able to work as a mechanic. The earlier the condition is treated, the more likely the patient is to make a full recovery.
