Bloodwork, also known as blood tests, are an important diagnostic tool that doctors use to check for a wide variety of health conditions. But can routine blood tests detect something as serious as a brain bleed or hemorrhage? Let’s take a closer look.
What is a brain bleed?
A brain bleed, also known as a brain hemorrhage, occurs when an artery in the brain ruptures or leaks, causing bleeding into the surrounding brain tissue. This can cause swelling, pressure, and damage to the brain.
There are several types of brain bleeds:
- Intracerebral hemorrhage – bleeding within the brain tissue
- Subarachnoid hemorrhage – bleeding between the brain and the tissue covering the brain
- Subdural hematoma – bleeding between the dura (the outermost membrane covering the brain) and the arachnoid membrane
- Epidural hematoma – bleeding between the dura and the skull
Brain bleeds are serious medical emergencies. They can occur spontaneously, often due to uncontrolled high blood pressure or aneurysms, or may be triggered by head trauma. Symptoms depend on the location and severity of the bleed but may include sudden, severe headaches, numbness, weakness, vision changes, dizziness, nausea, vomiting, seizures, and loss of consciousness.
What blood tests may be done for a suspected brain bleed?
If a brain bleed is suspected, a doctor will likely order blood tests as part of the diagnostic workup, along with brain imaging tests like a CT scan or MRI. Some blood tests that may be ordered include:
- Complete blood count (CBC) – evaluates levels of red blood cells, white blood cells, hemoglobin, and platelets. Significant drops may indicate internal bleeding.
- Prothrombin time (PT)/INR – measures blood clotting ability. Prolonged clotting times can point to coagulation problems.
- Partial thromboplastin time (PTT) – assesses intrinsic blood clotting pathways. Prolonged PTT may indicate bleeding disorders.
- Fibrinogen level – a low level indicates impaired blood clotting ability.
- D-dimer – a marker of abnormal clot breakdown that is elevated when blood clots form and break down in the body, as may occur with hemorrhage.
- Basic metabolic panel – analyzes sodium, potassium, chloride, carbon dioxide, blood glucose, calcium, and kidney function. Abnormalities may reflect electrolyte imbalances or organ impairment resulting from blood loss or injury.
However, while these blood tests may provide supporting evidence, none can definitively diagnose a brain bleed. Head imaging is required to confirm bleeding in the brain and pinpoint the exact location and extent of hemorrhage. Blood tests alone lack the precision to detect or rule out a brain bleed.
Are there any specific blood tests to detect a brain hemorrhage?
Unfortunately, there are no blood tests that can conclusively confirm or diagnose a brain hemorrhage on their own. Doctors mainly rely on imaging tests like CT scans and MRIs to definitively detect brain bleeding and assess the type, location and severity of hemorrhage.
Researchers have investigated certain proteins and biomarkers that may become elevated after a brain bleed, such as glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1). However, these are still considered experimental and not ready for routine diagnostic use for brain hemorrhage.
While blood tests may provide supporting information, direct visualization of the brain through CT or MRI remains the clinical standard for diagnosing a brain bleed.
Can bloodwork detect a slow brain bleed over time?
Unfortunately, standard blood tests like a complete blood count are not sensitive enough to detect an slowly progressing or intermittent brain hemorrhage over time. A slow brain bleed, also known as a chronic subdural hematoma, occurs when blood leaks from an artery and pools between the dura and surface of the brain. This often stems from a head injury that caused stretching and tearing of small bridging veins.
The blood leak is usually small and gradual, so the body is able to reabsorb the blood. But over weeks to months, repeated minor bleeding episodes can cause a larger hematoma to accumulate and put pressure on the brain. Symptoms of chronic subdural hematoma, like headache, confusion, and drowsiness, typically develop insidiously.
Since a slow brain bleed does not cause rapid blood volume loss, standard blood tests are unlikely to detect significant abnormalities until late in the course of disease. MRI or CT imaging is required to diagnose a chronic subdural hematoma.
Can blood tests distinguish a brain bleed from other conditions?
Blood tests on their own have very limited ability to differentiate a brain hemorrhage from other medical conditions that may have overlapping symptoms, such as:
- Migraine headache
- Stroke
- Brain tumor
- Seizure
- Concussion
- Electrolyte imbalance
- Infection like meningitis
There is no single blood biomarker that can reliably distinguish a brain bleed from these other potential causes of similar symptoms. Some conditions like stroke and brain tumor may also result in subtle blood test abnormalities that are not specific enough to confirm a diagnosis. The results must be interpreted in context with the full clinical picture.
Advanced neuroimaging is required to differentiate between possible causes and definitively diagnose a hemorrhagic stroke or other intracranial bleed. While blood tests provide supporting data, they ultimately cannot confirm whether bleeding is present in the brain.
Can blood tests assess the severity of a brain hemorrhage?
Blood tests have very limited utility in pinpointing the severity or impact of a brain bleed. They may provide some supporting details but do not give precise information about:
- The exact location of the hemorrhage in the brain
- The size and volume of hemorrhage
- Whether critically important brain regions are affected
- If there is swelling, hydrocephalus, or shifting of brain tissue
- How much pressure the bleed is exerting in the cranial vault
These factors require direct visualization of the brain with CT or MRI scanning. The results are quantified using scoring systems like the ICH score and Graeb score to assess severity.
Blood tests may hint at the extent of injury by indicating secondary impacts like electrolyte imbalances, organ damage from pressure effects, or degree of anemia from blood loss. However, they cannot substitute for brain imaging in evaluating the primary hemorrhage itself.
Can blood tests detect a past or old brain bleed?
Blood tests are generally not useful in identifying evidence of a prior brain hemorrhage after the acute phase has resolved. Once a significant amount of time has passed, blood levels of cells, proteins, and biomarkers related to active bleeding would return to normal.
CT and MRI scans, on the other hand, can often identify residual traces of previous bleeding and breakdown of blood products even long after a hemorrhage. This includes:
- Hemosiderin deposits
- Gliosis or scarring
- Cystic encephalomalacia
- Cerebral atrophy
- Calcifications
These changes would not be reflected in routine bloodwork. A brain MRI can detect old microhemorrhages and macrohemorrhages that may not have caused any acute symptoms. Therefore, neuroimaging remains the most useful means of uncovering evidence of prior asymptomatic or mild brain bleeds.
What are the main limitations of blood tests for detecting brain bleeds?
There are several reasons why blood tests alone cannot reliably identify or evaluate brain hemorrhage:
- Blood levels are an indirect, downstream indicator and may not reflect findings visible on brain imaging.
- There are no blood biomarkers specific and sensitive enough to detect brain bleed.
- Slowly progressing bleeds may not alter blood components until late stages.
- Bloodwork cannot pinpoint location, size, or acute effects on brain tissue.
- Previous bleeds may leave no residual abnormalities in blood after resolution.
- Similar blood test changes may be seen in many medical conditions besides hemorrhagic stroke.
Summary
In summary, blood tests or bloodwork cannot definitively diagnose or exclude a brain hemorrhage. While they may provide some supporting information, blood tests alone lack the necessary specificity to detect brain bleeding.
Doctors rely heavily on brain imaging studies like CT scans and MRIs to confirm that bleeding is present in the brain parenchyma or surrounding spaces. Neuroimaging can also characterize the precise location, extent, type, and acuity of hemorrhage – details that blood tests cannot provide.
Certain blood biomarkers signaling disruption of the coagulation system, red blood cells, and brain neurons may raise suspicion of a brain bleed. However, these changes are not sensitive or specific enough to replace proper diagnostic imaging of the brain itself.
Blood tests do play a role in elucidating the medical history, assessing overall health impact, and monitoring for secondary complications in a patient with a known brain hemorrhage. But solely relying on bloodwork to screen for or diagnose a brain bleed would be inaccurate and unsafe.
In the future, researchers hope to develop newer blood biomarkers that may have promise in identifying brain hemorrhage quickly and reliably. But for now, direct visualization of the brain with CT and MRI remains the clinical standard.
