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Did Your Newborn Suffer Cerebral
Palsy or Another Brain Injury Before
or During Labor and Delivery?

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Our Birth Brain Injury Resource Guide

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Get a FREE guide of resources available throughout Ohio to children and families of children who were born with brain injuries.

Our guide can help you build a foundation of knowledge and tools that will help you help your child
now and in the future.

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Hemorrhage - Causes

A subarachnoid hemorrhage refers to bleeding that occurs in the subarachnoid area – this is the area found between the brain and the tissues that cover it.

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It is within this space in the brain where the cerebrospinal fluid flows around, and it is this space that is in charge of protecting our brains from injury by acting as a protective cushion. When a hemorrhage occurs in this area of the brain, it can lead to a coma, paralysis, and sadly, even death. While it is very rare for a subarachnoid hemorrhage to occur in infants and babies, it is usually as a result of trauma to the brain during birth
A subarachnoid hemorrhage tends to occur very quickly and, as mentioned, is usually the result of a head trauma. The key to surviving is immediate and swift medical attention.

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A History of Subarachnoid Hemorrhages

The signs and symptoms of this kind of bleeding tend to range from highly subtle prodromal events to the more classic presentation. Prodromal events can be easily misdiagnosed, but the classic presentation of symptoms usually gives the most pathognomonic pictures in clinical medicine.

Typical prodromal events tend to occur once a cerebral aneurysm ruptures. The most common symptoms in babies include loss of consciousness, seizures, difficulty sleeping, and difficulty feeding.

The Causes of a Subarachnoid Hemorrhage

Most cases of this type of hemorrhage are due to a trauma to the head. In the majority of cases of spontaneous hemorrhage, the cause is a ruptured cerebral aneurysm, which occurs when the wall of one of the arteries weakens in the brain and becomes enlarged. While most cases of these hemorrhages are due to small aneurysms bleeding, larger and less common aneurysms are a lot more likely to rupture.

In around 15 – 20 percent of cases, an aneurysm is not detected in the initial angiogram. Furthermore, about half of all cases are attributed to non-aneurysmal hemorrhaging whereby blood is limited to the subarachnoid area of the midbrain. In such cases, it is uncertain where the blood originates from. Other cases are usually due to disorders that affect the blood vessels, bleeding into tumors, disorders of the blood vessels in the spinal cord, and, in children, sickle cell anemia.

Usually, subarachnoid bleeding can be detected with the use of a CT scan in around 60 percent of people who have had a traumatic brain injury. Such injuries tend to happen near the site of a skull fracture and have been linked with a poorer prognosis. However, it remains unclear if the presences of blood in the subarachnoid space is an indicator of how severe the head trauma is.

While a brain aneurysm will not always rupture, a procedure to prevent a subarachnoid hemorrhage is often recommended if they are detected early enough.

Other Causes of This Type of Brain Hemorrhage

There are several less common causes of a subarachnoid hemorrhage, such as:

  • A brain infection. For example, encephalitis
  • Arteriovenous malformations, which occur when blood vessels develop abnormally
  • Vasculitis, which happens when the blood vessels inside a baby’s brain become swollen and inflamed, leading to a wide variety of issues, such as the immune system attacking healthy tissue, or a serious infection
  • A brain tumor that damages the blood vessels. Both non-cancerous and cancerous brain tumors may lead to a subarachnoid hemorrhage
  • Moyamoya disease, which is a rare condition that results in blockages in the arteries of the brain
  • Fibromuscular dysplasia – this is a very rare condition that can lead to the arteries narrowing

Risk Factors for a Hemorrhage

A subarachnoid hemorrhage can occur at any time in a person’s life, and some babies are born with cerebral aneurysms that can result in bleeding on the brain. It has been reported that females are more likely than males to develop a brain aneurysm, and therefore a subarachnoid hemorrhage.

For babies, it is important to act quickly to stop the bleeding and prevent other complications such as brain damage and cerebral palsy. Often, cooling therapy, where the baby’s core temperature is lowered for several days to stop the bleeding, is used and has proven successful, especially in preventing brain damage.