A Brain Tumor Complication: Bleeding and Stroke

An Infrequent Cause of Intracranial Hemorrhages

One complication of brain cancer is bleeding within the brain (called an intracranial hemorrhage) which can then cause a stroke.

Let's delve into the details surrounding brain tumors and intracranial hemorrhages. This way, if you or a loved one has experienced an intracranial hemorrhage from cancer, you can hopefully feel a bit more at ease knowing the basics and what to expect.

Types of Brain Tumors

There are two main types of brain tumors, and either one can develop bleeding.

 

Primary Brain Tumor

One type is called a primary brain tumor because it originates within the brain tissue. Examples of primary brain tumors include pituitary tumors, gliomas (generally fast-growing tumors) and meningiomas, which are generally slow-growing and benign—so not cancerous.

Metastatic Brain Tumor

Metastatic tumors are cancers that start in one area of the body (such as the lungs, breast, or kidneys) and spread to another part of the body.

It's worthy to note that cancer that has spread to the brain is not called brain cancer. Rather, it's called by the name of the place where that cancer began. For example, if cancer originates in the lung and spreads to the brain, it's called metastatic lung cancer or more specifically, lung cancer that has metastasized to the brain. 

Likelihood of a Brain Tumor Bleeding

Bleeding from a primary brain tumor is actually a relatively rare event, accounting for a small percent of all causes of intracerebral hemorrhage.

More common causes of intracerebral hemorrhage include high blood pressure, amyloid angiopathy, head trauma, and illegal drug use (usually amphetamines and cocaine)

Still, a brain tumor's tendency to bleed depends on the tumor's characteristics. For instance, pituitary tumors are prone to bleeding whereas meningiomas rarely cause bleeding.

In addition, brain metastases from certain cancers like kidney cancer or melanoma are more prone to spontaneously bleeding. On the flip side, brain metastases from breast cancer generally do not bleed.

Symptoms of Hemorrhagic Stroke Caused by a Brain Tumor

The symptoms of a stroke caused by an intracerebral hemorrhage are different from typical stroke symptoms. This is because most strokes happen due to a sudden blockage of blood flow to a region of the brain, which causes stroke symptoms to develop suddenly. By contrast, tumors in the brain slowly grow into the brain tissue, so stroke symptoms develop gradually, over days, weeks, or months.

The exact symptoms of bleeding from a brain tumor depend on several factors. Most importantly, the amount of blood that enters the brain tissue determines whether symptoms will be minor or substantial. The symptoms of a bleeding brain tumor also depend on where the bleeding takes place because bleeding in one region in the brain causes neurological symptoms that are different from those caused by bleeding in another region. Thus, signs of bleeding in the brain can range from a simple headache to life-threatening paralysis.

Even so, the most common symptoms of a bleeding brain tumor include:

  • Weakness of the face and/or arm, and/or leg on one side of the body
  • Numbness in the face, and/or arm, and/or leg on one side of the body
  • Inability to understand spoken language or inability to speak
  • Inability or difficulty writing or reading
  • Vertigo and/or with or without nausea or vomiting
  • A severe headache or double vision
  • Changes in vision or vision loss
  • Seizures or convulsions

Diagnosis of a Bleeding Brain Tumor

Bleeding from a brain tumor is usually diagnosed with a CT scan. With a CT scan of the brain, the area of bleeding typically appears as a bright white area, in contrast to the grayish appearance of the normal brain tissue.

In addition, the blood in the brain is typically surrounded by a darker area, which represents brain swelling.

Most injuries and damage to the brain, including strokes and brain tumors, cause swelling, and it's the shape and size of the swelling that help doctors determine whether the bleeding is the result of a brain tumor or the result of another condition, such as head trauma or a bleeding blood vessel.

Generally, if there is any suspicion that the bleeding is caused by a brain tumor, the next test is usually an MRI of the brain, along with an injection of a contrast material known as gadolinium. This contrast material helps delineate among areas of healthy brain tissue, areas of blood, and areas of cancerous tissue.

Treatment of a Bleeding Brain Tumor

Overall, the treatment of bleeding in the brain caused by a brain tumor depends on the amount of blood and the symptoms it causes. The standard treatment is to remove both the blood and the tumor at the same time. However, sometimes, when the amount of blood is very small, and the person's symptoms are minor (for example, a headache), surgery may not take place right away.

Usually, if it's safe to wait for a few weeks before surgery, other tests can be performed to help confirm the origin of the brain tumor (whether it's primary or metastatic). Then, if there is cancer elsewhere in the body, an oncologist can decide whether or not other cancer treatments are needed, such as radiation and chemotherapy.

A Word From Verywell

If you or a loved one has had a brain hemorrhage caused by a tumor, you will need to follow very closely with a medical team, including an oncologist, a neurologist, and a neurosurgeon. While recovery may be slow and exhausting, both physically and mentally, with strong support from loved ones and your healthcare team, you can get through it.

Sources:

Caplan LR. (2017). Overview of the evaluation of stroke. Kasner SE, ed. UpToDate. Waltham, MA: UpToDate Inc.

Hainline C et al. Tumoral presentation of homonymous hemianopia and prosopagnosia in cerebral amyloid angiopathy-related inflammation. J Neuroophthalmol. 2017 Mar;37(1):48-52.

Lee EQ, Wen PY. (2017). Treatment and prevention of venous thromboembolism in patients with brain tumors. Leung LLK, ed. UpToDate. Waltham, MA: UpToDate Inc.

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