Is a CT scan sufficient to determine the status of a brain hemorrhage?

1 answer | Last updated: Oct 23, 2016
A fellow caregiver asked...

My father had a major brain hemorrhage 3 months ago and has now returned home on a walking frame. He was extremely ill and had to spend time in a capital city rehabilitation centre. He has just returned home to his country doctor who has told him his brain hemorrhage was a burst blood vessel in the brain and all he has to do now is have a CT scan to check it is healing OK. His last 2 CT scans taken 2 months ago were so filled with blood they could not see anything so I am not sure how the country doctor knows it was only a burst blood vessel.

Consequently, dad is now canceling the MRI scan booked in a capital city by a previous doctor as the country doctor told him the CT scan will show up whatever he needs to know just the same as an MRI. Is this true? My mother thinks that the radioactivity from CT scans is bad and the radioactivity from MRI scans are bad. I am not sure there is any radioactivity in MRI scans as I have heard they are radio waves and magnetic waves and I don't know what they do to you.

Can you tell me what should be getting done for a person who has had a bleed in the brain that has just been a burst blood vessel that caused a major bleed? Also what is best an MRI or a CT scan or are they both efficient for dad's purposes? Thanks for the help.

Expert Answers

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

The most common causes of intracranial hemorrhage are 1) high blood pressure, 2) vascular abnormality, and 3) age related changes to the small outer vessels of the brain (protein build-up making the vessels easily breakable). Other less common causes include a clot in a vein or a tumor.

Often, a CT is sufficient to make the diagnosis of a blood pressure related hemorrhage. If the bleed was deep - in parts of the brain referred to as the "basal ganglia" or "cerebellum", particularly in someone with a history of high blood pressure, often a head CT is all that is needed. However, if your dad has 1) no history of high blood pressure, 2)is 65 years of age or under, and/or 3) had his hemorrhage in an outer part of the brain, I often suggest doing further work-up including an MRI and possibly even a catheter angiogram (similar to the angiograms that are done for heart patients).

An MRI gives no "radiation". It uses magnets and radio waves, and is not thought to be associated in any way with cancer causing radiation. It is generally regarded as much safer than CT.

I don't want to disagree with one of your doctors. However, if the specialist in the city felt an MRI was necessary, my guess is that it is. I would probably go ahead and get the MRI unless your local doctor has specifically spoken with the specialist in the city, and they both agree that the test can be cancelled. An MRI is often very helpful at determining an underlying cause for the bleeding.