Overview.
An intracranial hematoma is an accumulation of blood outside of the blood vessels in the skull, most commonly due to spontaneous rupture of blood vessels in the brain or trauma such as a car accident or fall. The blood accumulation can be within the brain tissue or beneath the skull, compressing the brain tissue.
While some head injuries – such as a head injury that causes only a brief loss of consciousness (concussion) – may be small, an intracranial hematoma can be life-threatening. It usually requires immediate treatment, often requiring surgery to remove the hematoma.
Symptoms.
You may have signs and symptoms of an intracranial hematoma immediately after a blow to your head, or it may take several weeks or longer for them to appear. You may seem fine early after a head injury, and we refer to this period as the intermediate lucid period. However, over time, the pressure of the hematoma on your brain increases, producing some or all of the following signs and symptoms: worsening headache, vomiting, drowsiness and progressive loss of consciousness, dizziness, confusion, unequal pupil size, slurred speech. As more blood presses against your brain or the narrow space between your brain and skull, other signs and symptoms may become apparent, such as: drowsiness, seizures, unconsciousness.
When should I see a doctor?
An intracranial hematoma can be life-threatening and requires emergency treatment. If you receive a blow to the head, seek immediate medical attention for the following conditions: loss of consciousness, persistent headache, difficulty with vomiting, weakness, blurred vision, unsteady gait, etc. If you receive a blow to the head and no obvious signs and symptoms appear, pay close attention to physical, mental and emotional changes. For example, if someone seems fine enough to talk after a blow to the head, but later becomes unconscious, seek immediate medical attention. Also, even if you feel fine, ask someone else to keep an eye on you to observe the changes. Because a blow to your head can cause memory loss to the point that you forget you ever had an injury. The person you tell is more likely to recognize your changes and take you to a doctor in time.
Causes of bleeding.
Head injuries, often from motor vehicle or bicycle accidents, falls, assaults and sports injuries, are the most common cause of intracranial hemorrhage (hematoma).
Even mild head trauma can cause a hematoma if you are an older person, especially if you are taking anticoagulants or antiplatelet medications such as aspirin.
Even if there is no open wound, bruise, or other obvious injury, serious intracranial damage can result.
There are three types of hematomas-subdural hematomas, epidural hematomas, and intracerebral parenchymal hematomas.
Subdural hematomas
are usually caused by a rupture of the pontine vein (the vein that connects the brain to the dura mater that covers the brain). The leaking blood forms a hematoma that compresses the brain tissue. An enlarged hematoma can lead to gradual loss of consciousness and death.
The three types of subdural hematomas are
Acute: This is the most dangerous type. It is usually caused by a severe head injury and the signs and symptoms are usually immediate.
Subacute: Signs and symptoms take a while to appear, sometimes days or weeks after the injury.
Chronic: Caused by minor head trauma, bleeding is slow and symptoms may take weeks or even months to appear. You may not even remember that you have ever had a head injury. For example, hitting your head while entering a car can cause bleeding, especially if you are taking blood-thinning medication.
All three types require medical attention once signs and symptoms are noticed to prevent permanent brain damage. The risk of subdural hematoma increases with age. The following people are at greater risk and take daily aspirin or other blood-thinning medications
Epidural hematoma.
This is usually due to a rupture of an artery between the outer surface of the dura mater and the skull. Blood then leaks between the dura and the skull, forming a hematoma that compresses the brain tissue. The most common cause of an epidural hematoma is trauma.
Some people with this injury remain conscious, but most are lethargic or comatose from the moment of trauma. An epidural hematoma affecting a large artery can be fatal if not treated promptly.
Intracerebral parenchymal hematoma.
This type of hematoma, also known as an intracerebral hematoma, occurs when blood circulation leaks within the brain tissue. There are many causes, including trauma, ruptured aneurysms, vascular malformations, hypertension, and tumors. There are also diseases that may cause spontaneous leakage of blood into the brain. Head trauma can lead to multiple severe intraparenchymal hematomas.
Diagnosis.
Diagnosing an intracranial hematoma can be difficult because people with head injuries can present seemingly well. However, physicians often assume that intracranial hemorrhage is the cause of progressive loss of consciousness following a head injury until evidence confirms otherwise.
Imaging tests are the best way to determine the location and size of a hematoma. These include
CT scan: CT is the most common scan used to diagnose intracranial hematomas.
MRI scans: MRI is not used as often as CT scans to diagnose intracranial hematomas because MRI takes longer to perform and is not as widely available.
Angiography: If there is concern about a restricted bulge in a cerebral blood vessel (aneurysm) or other vascular problem, an angiogram may be needed to provide more information.
Treatment.
Small hematomas that do not produce signs or symptoms do not need to be removed. However, because signs and symptoms may appear or worsen days or weeks after the injury, you may need to be monitored for neurological changes, receive intracranial pressure monitoring and have repeat CT scans of your head.
If you are taking blood-thinning medications, such as warfarin, you may need treatment to reverse the effects of the medications and reduce the risk of further bleeding. Ways to reverse the effects of blood thinners include giving vitamin K and fresh frozen plasma.
Surgery.
Hematoma treatment usually requires surgery. The type of surgery depends on the type of hematoma you have. Options include
Surgical drainage. If the blood is confined and does not clot, your surgeon may drill a hole in your skull and use suction to remove the fluid.
Craniotomy. A large hematoma may require opening a portion of your skull (craniotomy) to remove the hematoma.
Recovery.
Recovery from an intracranial hematoma may take a long time, and you may not fully recover. Recovery is fastest in the first three months after the injury, and usually slows down after that. If neurological problems continue after treatment, you may need specialized rehabilitation.
Self-management.
Treating a brain injury requires a lot of patience. Adults will have the vast majority of their recovery in the first six months after the injury. You may have a slower, more gradual improvement for up to two years after the bleed.
The following factors will aid recovery.
Getting enough sleep at night and resting when you feel tired during the day.
When you feel stronger, you can easily return to normal activities.
Do not participate in impact sports until your doctor gives you permission.
Check with your doctor before you start driving, riding a bicycle, or operating heavy machinery. Your reaction time may be slowed by your brain injury. Consult your doctor before taking medication. Do not drink alcohol until you have fully recovered. Alcohol may hinder recovery, and drinking too much alcohol can increase your risk of a second injury. Write down what you can’t remember. Talk to someone you trust before making important decisions.
Prevention
To prevent or reduce head injuries.
Wear a helmet while making sure your child wears one. Wear a proper helmet when playing rushing sports, riding a bicycle, motorcycle, skiing, horseback riding, skating, snowboarding, snowboarding or doing any activity that could cause a head injury.
Buckle up your seat belt and make sure it is buckled for your child as well. Do this every time you drive or ride in a car.
Protect young children. Always use properly installed child seats and add padding to countertops and table edges. Bind heavy furniture to walls to prevent tipping and prevent children from climbing on unsafe or unstable objects