Symptoms of a cerebral hemorrhage


At a Cerebral hemorrhage it is definitely one medical emergencywhich must be dealt with as soon as possible. The term cerebral hemorrhage is slang for a number different bleeding within the skull used. So must basically of bleeding between the brain and the skull as well as bleeding within the brain.
Depending on the person concerned Blood vessel that collects blood in different places within the skull.

In a cerebral hemorrhage in the narrower sense, a blood vessel is affected, which runs within the brain. If this tears, a hematoma develops within the brain. This is dangerous because there is only limited space available within the skull and with a growing bruise there is a risk of entrapment of important brain areas. The bleeding causes symptoms that can vary greatly depending on the extent and location of the bleeding.

Read more on the topic: What are the causes of a cerebral hemorrhage

Illustration of a cerebral hemorrhage

Figure cerebral hemorrhage: in the area of ​​the brain tissue and meninges

Cerebral haemorrhage (cerebral haemorrhage)

  1. Skull roof -
  2. Hard meninges (dura) -
    Cranial dura mater
    (outermost meninges)
  3. Subdural gap -
    Subdural space
  4. Cobweb skin of the brain -
    Arachnoid mater cranialis
    (middle meninges)
  5. External cerebral water space -
    Subarachnoid space
  6. Cerebrum covered by soft
    Meninges (pia) -
    Pia mater cranialis
    (inner meninges)
  7. bruise
    (Hematoma) in brain tissue
    Bleeding in the area of ​​the brain tissue
    and the meninges:
    A - Intracerebral Haemorrhage (ICB) -
    Bleeding into the brain tissue
    (Parenchyma) by bursting a cerebral vessel
    B - Epidural Bleeding -
    Blood between the bones of the skull and the
    outermost meninges (Dura mater)
    C - Subdural Bleeding -
    Blood between the meninges
    and cobweb skin
    D - subarachnoid hemorrhage -
    Blood between cobweb skin and
    the inner (soft) meninges

You can find an overview of all Dr-Gumpert images at: medical illustrations


In the case of cerebral hemorrhages, a distinction must be made between where and from which vessels it occurs.

The specific symptoms of a cerebral hemorrhage are very similar to the symptoms of a cerebral infarction. In both diseases, an impairment of the respective brain areas is the reason for the development of the symptoms.
You can find more information about this on our website Signs of stroke.

Common symptoms of a cerebral haemorrhage are headache, nausea and vomiting, visual disturbances, sensory disturbances, swallowing disorders, paralysis on one side of the body, dizziness, and seizures.With advanced entrapment of certain areas of the brain, it can lead to unconsciousness and respiratory failure.

Read more on the topic: What are the signs of a cerebral hemorrhage?

Headache as a symptom

In most cases, a cerebral hemorrhage causes a very severe headache. Most people describe the headache as "stronger than ever" and "devastating". In the case of a very severe headache, which has never occurred in this form before, a doctor should therefore be consulted to clarify a cerebral hemorrhage. A so-called "Annihilation pain"is typical of a rupture of a cerebral artery aneurysm.

Read more on this topic: Cerebral artery aneurysm

The headache that occurs as part of a cerebral haemorrhage can be explained by the increase in volume within the skull. The increase in volume and the limited space inside the skull creates pressure on the meninges, which are supplied with nerves. This pressure causes the headache, which is why it can be a sign of an existing cerebral hemorrhage.

Nausea as a symptom

Nausea is a very common and early symptom of cerebral hemorrhage. Together with vomiting and headaches, this can be an important indicator of a cerebral haemorrhage. The nausea is triggered by a special area in the brain stem. This so-called “crushing center” is very sensitive and reacts to an increase in pressure.
Typically, nausea and vomiting occur as part of a cerebral haemorrhage, as the bleeding increases the pressure in the skull and activates the vomiting center.
This symptom can also often be found in tumors in the brain. Various drugs can target the vomiting center in the brain and reduce the nausea caused by a cerebral hemorrhage.

Vomiting as a symptom

Vomiting and nausea usually go hand in hand. With strong increases in pressure in the brain, as part of a cerebral hemorrhage, nausea can occur.
It is also a typical symptom of severe cerebral haemorrhage. Vomiting only subsides after the pressure has been reduced or certain medication is given.

Pupil difference as a symptom

With a cerebral hemorrhage, there is usually a volume-related narrowing of certain cranial nerves. Depending on the nerve affected, different symptoms can occur. An important symptom, which can be an indication of the presence of a cerebral hemorrhage, is the so-called pupillary difference.
The size of the affected person's two pupils is compared. If there is a difference in the size of the pupils in both eyes, there is an indication that there is a cerebral haemorrhage. Even if one or both pupils can no longer shrink in response to a light stimulus, a cerebral haemorrhage is suspected.
In both cases there is an acute need for medical action, as the situation is life-threatening.

For more information on the pupillary difference, see Different sized pupils.

Fever as a symptom

When a fever occurs, in most cases the body is responding to an infection. However, when a cerebral hemorrhage occurs, the coexistence of an infection is rarely the cause of a sudden fever.

Fever, which can be associated with a cerebral haemorrhage, can be caused by a so-called SIRS (systemic inflammatory response syndrome) occur. This severe body reaction is caused, for example, by major surgery or injuries.
In addition to fever, this disease also has an increased heart rate, rapid breathing and changes in the blood count.

Unilateral weakness as a symptom

Unilateral weakness can be a threatening symptom of cerebral haemorrhage and persist even after a long time. The weakness affects the muscles and is usually the first noticeable in the face, arms or legs.
In severe cases, the muscles can be paralyzed completely. The reason for this is the failure of the controlling structures in the brain.
The exact type of weakness depends heavily on the size and location of the cerebral hemorrhage. In the outer peripheral area of ​​the brain are the central controls for all movements that are triggered by muscles in the body. From there, the nerve tracts run into the spinal cord and then as a nerve to the respective muscle. On their way, the nerve cords cross the sides, which is why the half-sided weakness often occurs on the opposite side of the body from the cerebral hemorrhage.
At first glance, a cerebral hemorrhage cannot be distinguished from a stroke in terms of unilateral weakness.
Both diseases cause direct damage to nerve cells in the brain. The extent to which the nerve cells can regenerate and regain their function after cerebral hemorrhage is very different from individual to individual. A prognosis for the improvement of the one-sided weakness can therefore not be made with certainty.

One-sided paralysis as a symptom

The paralysis is the advanced form of one-sided weakness.
Here, too, in acute cases of cerebral hemorrhage, motor nerve cells in the cerebral cortex or nerve cords in their course to the muscle perish. As a result, electrical stimuli can no longer reach the nerves and muscles in the arms and legs.
As with a stroke, the paralysis can be noticed very suddenly, for example through a drooping corner of the mouth. In the case of complete paralysis, the nerve cells can partially regain their function during the healing phase. A full recovery from paralysis is questionable.

Numbness as a symptom

Numbness can go hand in hand with muscular weakness or paralysis. The cerebral hemorrhage damages nerves in their course, which forward sensitive information from the body to the brain.
The complete numbness of sensation is the most extreme form. Initially, tingling and pain can occur. An important differential diagnosis for cerebral haemorrhage is also a stroke in the case of numbness.

Speech disorder as a symptom

If there is a language disorder, there may be several causes. Most forms of speech disorders can be caused by a hemorrhage in the brain. Therefore, a concrete survey of the exact disorder present is important in order to narrow down the affected brain area and the damaged structures.
Initially, there may be a motor language disorder, which, similar to hemiplegia, is caused by damage to the nerve cells used for muscle movement. Deficits in the muscles of the mouth and larynx can lead to articulation and sound formation disorders. Such motor paralysis can also cause hoarseness.
With a cerebral hemorrhage, however, like a stroke, one of the language centers in the brain can be damaged. The two main areas of language education that can be affected are the Broca and Wernicke centers.
If the former fails, there will be speech formation disorders, which can manifest itself, for example, as stuttering and articulation problems. In so-called "Wernicke aphasia", speech understanding is damaged. Individual words do not occur to those affected or are replaced by similar-sounding sounds, so that sometimes a well-articulated, but meaningless language is created.
The severity of the speech disorder is highly dependent on the extent of the cerebral hemorrhage. Even with severe disorders, however, many skills can often be regained through years of practice.

Swallowing disorder as a symptom

The swallowing process is a neurologically complex interplay of sensory and motor processes. In the brain, swallowing is controlled by several centers and implemented in individual phases by the throat muscles.
Both in cerebral hemorrhage and in a stroke, damage to the individual structures involved can cause swallowing disorders.
If the upper part of the esophagus is disturbed, there is a risk of food entering the windpipe, which can cause pneumonia.

Visual disturbance as a symptom

Visual disturbances of many kinds are possible with cerebral haemorrhage, but generally occur rarely.
A visual impairment can range from double vision and reduced color and sharpness perception to loss of visual field and complete blindness. In the brain, the visual pathways that carry the signal from the eyes to the cerebral cortex may be affected, or the visual center of the cerebral cortex itself.
Tumors, strokes and severe head injuries can also cause such visual disturbances.

Epistaxis as a symptom of a cerebral hemorrhage?

In the vast majority of cases, nosebleeds can be classified as harmless. It is not of particular importance in the diagnosis of cerebral haemorrhage alone.
If you have a known cerebral hemorrhage, a nosebleed is very unlikely, but in very rare cases it can be a symptom of the bleeding. The nasal cavity is spatially close to the front, lower edge of the brain and can thus become symptomatic of various processes in the brain.
Cerebral haemorrhage can lead to an increase in intracranial pressure. This can damage small blood vessels that bleed into the nasal cavity. There in the tip of the nose there is a vascular network that is very sensitive to pressure and various forces and causes nasal bleeding.

Dizziness as a symptom

Dizziness is a very unspecific symptom that can have numerous causes.
In the case of a cerebral hemorrhage, dizziness can also occur. This is often due to anemia or a lack of oxygen in the brain. The dizziness can be the first symptom before a faint and unconsciousness.
Cerebral haemorrhage can also damage the organ of equilibrium. This is located in the inner ear and is elaborately interconnected in the brain in order to maintain a permanent balance. If the regions involved fail, dizziness attacks can occur.

Clouding of consciousness as a symptom

Consciousness is a body function that is difficult to measure and is based on the interplay of dozens of body functions. In general, consciousness includes the function of the senses, attention and alertness, as well as well-being.
Medically, consciousness can be divided into stages, whereby in most cases the coma represents the lowest level of consciousness, here one speaks of unconsciousness. Responses to speaking, touching and pain are important steps in consciousness.
In the context of a cerebral haemorrhage, the increasing hemorrhage and the subsequent swelling of the brain lead to a strong increase in intracranial pressure. This is often reflected in the brain stem, which controls the body functions. With increased pressure on the brain stem, it quickly comes to a clouding of consciousness and a subsequent loss of consciousness.
The unconsciousness can also be brought about with medication in order to spare the nerve cells for the healing process.

Epileptic seizure as a syndrome

A cerebral hemorrhage can be a typical trigger for an epileptic seizure.
The bleeding can cause a kind of scar in the nerve tissue of the brain, which can also favor epileptic seizures in retrospect. As a result, electrical signals are passed on in an amplified manner, which quickly leads to severe overexcitability of the cells.

Coma as a symptom

Severe cerebral hemorrhage can be associated with a coma.
The coma is the most severe form of complete unconsciousness. With certain cerebral hemorrhages, a kind of artificial coma can also be induced to protect the body for a certain period of time so that damaged areas of the brain can recover. During cerebral haemorrhage, it is not uncommon for the brain to swell and the pressure in the brain to rise sharply. The patient can fall into a coma due to the increasing pressure on vital areas of the brain, for example the brain stem.
A prognosis for people with a cerebral hemorrhage who are in a coma cannot be made. This is due to the fact that the brain can regenerate itself differently and thus potential consequential damage cannot be clearly predicted.

Read more on the topic: Cerebral hemorrhage and coma

Symptoms of cerebral haemorrhage in babies and premature babies

There is also a possibility of cerebral hemorrhage in babies and premature babies. Since the brain of premature babies is much more fragile, the probability that a premature baby will suffer a cerebral haemorrhage is significantly increased. The first days after birth are particularly critical with regard to the development of cerebral hemorrhage in newborns.

The symptoms of cerebral haemorrhage in babies and premature babies are generally similar to those in adults. However, since the children are difficult to describe the localization of pain, some of the classic symptoms of cerebral haemorrhage are eliminated.
In addition, the fontanelles on the head of babies and premature babies are still open. If the pressure in the skull increases, this can be carefully felt at the fontanelles. If the fontanelles bulge, there is an increase in pressure.

The causes of cerebral haemorrhage in babies and premature babies can be very different. In addition to congenital bleeding disorders, trauma and injuries can be the cause of bleeding in the brain.


A cerebral haemorrhage manifests itself as the strongest, destructive headache

The possible causes for the development of a cerebral hemorrhage are numerous. The ingestion of anticoagulant drugs cause of a cerebral hemorrhage. Also a high blood pressure, Brain tumors and Brain aneurysms can be responsible for bleeding in the brain.
Often there is also a Head trauma known as the cause of cerebral hemorrhage. This occurs cumulatively drunk people because the protective reflexes are absent in the intoxicated state and then a blow to the head is more likely.

A cause for the development of a cerebral hemorrhage cannot always be found.

Fall as the cause

Cerebral haemorrhage is not uncommon after a fall on the head. The blow can tear a vessel, causing bleeding and bruising in the brain. The symptoms immediately after the fall can be very mild. However, as the bleeding progresses, symptoms usually worsen if there is a cerebral haemorrhage.


The symptoms of a Cerebral hemorrhage occur are trend-setting for the diagnosis a cerebral hemorrhage. Depending on Amount of bleeding and the associated pressure increase and impairment more important annoy and areas of the brain, the symptoms can vary in severity.

If the data subject is still approachable describing the symptoms can help Suspected diagnosis to face a cerebral hemorrhage. At a comatose and unconscious patients Symptoms, which are discussed by a physical exam, may suggest a cerebral hemorrhage.
If a cerebral hemorrhage is suspected, it is usually a Computed Tomography carried out. During this examination, images of the head and brain and a cerebral haemorrhage can be detected within a very short time. If the diagnosis of cerebral haemorrhage can be made, therapy is initiated immediately.


The cerebral hemorrhage is a medical emergency that requires immediate therapy. Above all, it is important that the rising intracranial pressure is reduced in order to avoid life-threatening complications.

So-called diuretics can be administered. Medicines can also be given to lower blood pressure. If the intracranial pressure has risen to such an extent that breathing is suspended or threatened, artificial respiration can be given.

An operation is performed to relieve the strain on a massive increase in intracranial pressure. If necessary, the bleeding vessel can be closed during the operation.

The symptoms that occur with a cerebral haemorrhage, as well as diagnostic imaging, can help to make the right therapy decision.

For more information, read our topic: Cerebral haemorrhage therapy and surgery for a cerebral haemorrhage


The prognosis of a cerebral haemorrhage depends on the The extent and location of the bleeding such as individual risk factors differently. Minor bleeding generally has one more favorable forecast as extensive cerebral hemorrhage. The average death rate is around 30-50%.

The number of people affected who have persistent symptoms after a brain hemorrhage, such as Signs of paralysis or Speech disorders suffer is relatively high.


General prophylaxis cannot be recommended as there are a multitude of different causes for the occurrence of a cerebral hemorrhage. It is important that diseases that can lead to cerebral hemorrhage are treated. Furthermore, symptoms which indicate the presence of a cerebral hemorrhage should be taken seriously and clarified by a doctor.