How is it Diagnosed?
A brain hemorrhage, or intracranial hemorrhage, is a medical emergency that requires
prompt diagnosis to guide treatment and prevent complications. The process begins
with an evaluation of symptoms such as sudden severe headache, vomiting, seizures,
weakness, altered consciousness, or speech difficulties. A focused neurological
examination helps localize the lesion and assess severity.
The gold standard for initial diagnosis is a non-contrast CT scan of the brain, which can
quickly detect bleeding, including subarachnoid, intraparenchymal, subdural, or epidural
hemorrhage. CT is fast, widely available, and highly effective in the acute setting.
If the CT is inconclusive and clinical suspicion remains high, MRI, especially with
susceptibility-weighted imaging (SWI), provides greater sensitivity to detect smaller or
older bleeds. CT angiography or MR angiography is used to identify the source of
bleeding, such as aneurysms or arteriovenous malformations (AVMs). In cases of
subarachnoid hemorrhage without a visible source on non-invasive imaging, cerebral
angiography is the definitive diagnostic tool.
Lumbar puncture may be performed when imaging is inconclusive but subarachnoid
hemorrhage is suspected—this helps detect blood in cerebrospinal fluid (CSF). Blood
pressure evaluation and coagulation tests are also conducted to assess contributing
factors. Advanced labs may check for drug toxicity, particularly anticoagulant use.
Timely and accurate diagnosis is essential for surgical or medical management, as delay
can result in elevated intracranial pressure, herniation, or death.