By Kyle Mueller, MD, Neurosurgeon and Medical Director, Penn Medicine | Virtua Health Neurosciences Program at Virtua Our Lady of Lourdes Hospital

The winter’s bitterly cold and icy conditions make sidewalks and driveways slippery for everyone. And slippery surfaces can lead to falls, especially for older adults.

When you slip on ice, you have less time to brace yourself, increasing the risk of hitting your head on the ground.

A blow to the head from a fall can tear blood vessels inside the skull, causing blood to leak and put pressure on your delicate brain tissue—even if you don’t appear to have an external injury. This is called a subdural hematoma or brain bleed.

Who’s at risk for a brain bleed?

Not all slips and falls result in brain bleeds, but the risk increases with age. As you age, your brain shrinks slightly, putting pressure or tension on the veins close to the brain's surface. This makes hitting your head in a fall—or even bumping your head on a kitchen cabinet—a risk for a brain bleed.

What are the signs of a brain bleed?

Brain bleed symptoms can occur suddenly or develop in the hours, days, or even weeks after a head injury.

Brain bleed symptoms include:

• Headache
• Nausea or vomiting
• Dizziness
• Loss of consciousness
• Vision problems or light sensitivity
• Confusion or disorientation
• One-sided weakness or loss of balance

If you or a loved one experiences any of these symptoms after a blow to the head, seek immediate medical care at the ER.

Brain bleeds are typically diagnosed through a physical exam, medical history, a neurological exam to assess your mental status and cognitive abilities, and imaging tests, such as a CT scan or MRI.

How are brain bleeds treated?

Brain bleed treatment is individualized depending on the severity and location of the bleed, focusing on stopping the bleeding and reducing pressure within the skull. Here are some common treatments:

• Observation: Minor brain bleeds may not need immediate treatment, but close observation and monitoring are crucial to ensure symptoms don't worsen. A repeat CT scan can show if there's still bleeding or if pressure has increased in the brain. Medications may also be used to reduce swelling.
• Surgery: Surgery is used to treat a brain bleed that's putting pressure on the brain. Depending on the severity, a neurosurgeon would make either a small hole (burr hole) or a larger incision (craniotomy) to remove blood clots and alleviate pressure.

Some brain bleeds become chronic subdural hematomas, meaning blood leaks slowly over time, pooling on the brain's surface. In those cases, vascular surgeons may use a minimally invasive technique called middle meningeal artery (MMA) embolization to target and block the blood vessels that supply blood to the dura, the membrane that covers the brain.

In this procedure, the surgeon inserts a thin tube into a blood vessel in the wrist and guides it to the MMA. A special substance is injected through the catheter to block blood flow and stop the bleeding. Blocking the bleeding at the source can prevent recurrence.

Recovery after a brain bleed

After a brain bleed, especially in older adults, rehabilitation services may be needed to regain strength, improve balance, reduce fall risk, and assist with the tasks of daily living.

If you've had surgery, rehabilitation may start during your hospital stay and continue in a rehabilitation center or at home.

Recovery from a brain bleed takes time, effort, and proper treatment. Be patient with yourself while you’re healing.

The Virtua Difference for Neurosurgery

• At Virtua Our Lady of Lourdes Hospital, you can access nationally recognized care right in your neighborhood. We provide complex neurosurgical treatments, including emergency stroke care, brain tumor surgery, vascular microsurgery, spine surgery, and more. Through our partnership with Penn Medicine, you'll gain unique access to the nation's most qualified neurologists and neurosurgeons who can treat the rarest conditions.  
• Request a consultation with a Virtua Neuroscience specialist.