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Intracranial hematoma

Intracranial hematoma (ICH) refers to the accumulation of blood in the skull or brain usually due to the rupture of blood vessels and bleeding. The pooled blood creates pressure on the brain. Therefore, even in the absence of a visible external wound or bruise, there can be a serious internal damage. ICH is a life-threatening condition which needs immediate treatment.

Types

Based on the location of bleeding, ICH can be classified as follows:

  • Epidural hematoma is the collection of blood between the outermost covering of the brain and the skull.
  • Subdural hematoma is the accumulation of blood on the surface of the brain.
  • Intraparenchymal hematoma is the pooling of the blood in the brain.

Symptoms

Signs and symptoms can develop either immediately or after few weeks from the occurrence of blow to the head. The signs and symptoms are due to an increase in pressure on the brain and include the following:

  • Sudden and severe headache which progressively increases
  • Neck stiffness
  • Drowsiness and dizziness
  • Progressive loss of consciousness
  • Confusion
  • Slurring of speech
  • Unequal pupil size
  • Vomiting more than twice in a day

As the condition worsens, the following signs and symptoms may appear due to narrowing of space between the brain and the skull:

  • Seizures
  • Unconsciousness
  • Coma
  • Lethargy

Consult the doctor immediately if there is persistent headache, unconsciousness, or problems such as vomiting, weakness, unsteadiness or blurred vision after a blow to the head. 

Causes

The most common causes of intracranial hematoma are trauma or an injury to the head due to motor vehicle accidents, sports or falls. The other causes include high blood pressure, tumors, and malformations in the blood vessels.

Risk factors

Certain modifiable (lifestyle) and non-modifiable factors put a person at an increased risk of intracranial hematoma. They include:

  • Use of anti-platelet drugs such as aspirin
  • Alcohol consumption which increases the risk of accidents
  • Cigarette smoking
  • Hypertension
  • Extreme physical exertion
  • Old age
  • A family history of ICH

Diagnosis

It is sometimes challenging to diagnose ICH because the patient seems to be normal even after the head injury. In general, the doctor assumes hemorrhages inside the skull as the possible cause of unconsciousness and proceeds with the diagnosis.

Initially, the doctor recommends a CT scan to check for any abnormalities such as swelling or clotting in the brain. CT scan is the most commonly used imaging test to diagnose ICH as it gives quick results. Other imaging tests which may be required include an angiogram to identify the blood vessel problems and an MRI scans.

The doctor may also perform a spinal tap or lumbar puncture to examine the cushioning fluid in the brain and the spine.

Treatment

Intracranial hematoma needs emergency treatment. Outcome depends on the severity of hemorrhage and the promptness of treatment provided. The treatment approaches for ICH are as follows:

Medications

  • Anticoagulants are given to reduce the risk of clotting
  • Anti-seizure medicines are given reduce the risk of seizures
  • Steroids are prescribed to relieve swelling 

Often a surgery may be necessary to reduce the pressure on the skull associated with hematoma. The surgical options include:

  • Surgical drainage is a method in which a small hole is created in the skull to drain the blood by suction. It is used when the blood is localized and clots at a relatively slow rate.
  • Craniotomy is a method in which a part of the skull is exposed to remove the blood. It is performed to treat large hematomas.

Some patients may need a physical or an occupational therapy to carry out their normal activities.

Prevention

The following measures can help to prevent the risk of intracranial hematomas especially associated with head injuries:

  • Wearing a helmet while driving, playing certain sports, skating, or other such activities which are associated with the risk of head injury
  • Wearing the seat belt
  • Taking measures to prevent falls

 

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