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Intracranial Hematoma

Definition


Disease: Intracranial Hematoma Intracranial Hematoma
Category: Surgical diseases
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Disease Definition:

As blood vessel ruptures within the brain or between the skull and the brain, an intracranial hematoma occurs. The accumulated blood (hematoma) may compress the brain tissue.

An intracranial hematoma may occur due to the inability of the fluid surrounding the brain to absorb the force of an abrupt blow or a quick stop. In which cases, the brain may slide forcefully against the inner wall of the skull and become bruised.

An intracranial hematoma is a serious and possibly life-threatening condition that usually needs prompt treatment right away even though head injuries can be minor in times.

Usually, surgery is needed to treat an intracranial hematoma in order to remove the blood. Yet, surgery may not be needed when intracranial hematoma is smaller.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Intracranial hematoma signs and symptoms may either occur immediately after a blow to the head, or up to several weeks or longer from then. It’s even possible for one to appear perfectly alright after a head injury. This is known as the lucid interval. Pressure on the brain increases over time, producing some or all of the following signs and symptoms:

 

 

  • Vomiting
  • Pupils of unequal size
  • Increasing headache
  • Increased blood pressure
  • Drowsiness and progressive loss of consciousness
  • Dizziness
  • Confusion
  • Weakness in limbs on one side of the body

 

Other signs and symptoms such as the following may be apparent as more and more blood accumulated in the brain or in the narrow space between the brain and skull.

 

 

  • Seizures
  • Unconsciousness
  • Lethargy

 

Emergency medical treatment is usually required for an intracranial hematoma can be life-endangering.
Medical attention should be sought immediately after any significant blow to the head in which:

 

 

  • When one goes through any of the signs and symptoms indicating intracranial hematoma
  • One loses consciousness

 

Watching closely for subsequent physical, emotional and mental changes would be wise, even though symptoms of intracranial hematoma may not be apparent immediately.

For instance, when someone appeared to be fine after a blow to the head and was talking to someone else, but then lapses into unconsciousness, then medical care should be provided right away.
Additionally, informing a family member or a close friend when going through any kind of head trauma would be wise. One may forget that they even have suffered a blow to the head due to memory loss usually being related to head trauma. An alerted friend, work colleague or a family member may be more likely to be aware of the warning signs and arrange for prompt medical attention when they know of the injured person’s history.

Causes:

An injury to the head is the main reason behind the occurrence of intracranial bleeding (hemorrhage) which usually is caused by an automobile or motorcycle accident or a seemingly trivial event like bumping the head. There’s a greater likelihood for mild head trauma to result in a hematoma when one’s an older adult, particularly when they’re taking an anticoagulant or anti-platelet drugs, like aspirin. A serious injury may have occurred even if there's no open wound, bruise or other outward sign of damage.
In case the injury to the head causes hematoma, it may be a subdural, an epidural or an intraparenchymal hematoma.


Subdural hematoma
When blood vessels, usually veins, rupture between the brain and the outermost of three membrane layers covering the brain (dura mater), subdural hematoma occurs. The leaking blood forms a hematoma compresses the brain tissue. If the hematoma keeps growing, a progressive decline in consciousness occurs, possibly even resulting in death.

There are three types of subdural hematomas:


Acute: The most serious and possibly life-threatening type is the acute subdural hematoma. It results from a severe head injury in general, and signs and symptoms are often apparent immediately.
Subacute: Signs and symptoms take longer to appear in subacute subdural hematoma. Sometimes days or weeks after the injury.
Chronic: Less severe head injuries may result in a chronic subdural hematoma. Bleeding from chronic subdural hematoma may be much slower, and symptoms can potentially take weeks to appear. One may even forget they’ve had an injury to the head.
Medical attention is necessary for all three kinds of subdural hematomas as soon as signs and symptoms become apparent, or permanent damage may result.
People abusing alcohol, using aspirin or anticoagulants on daily basis or are simply very old are at greater risk of subdural hematoma.


Epidural hematoma
Also known as extradural hematoma occurs when a blood vessel, usually an artery, ruptures between the outer surface of the dura mater and the skull. Blood then leaks between the dura mater and the skull forming a mass that compresses the brain tissue.
Some people suffering from this kind of injury may stay conscious, but most become drowsy or comatose from the moment of trauma. The risk of dying of an epidural hematoma that affects an artery in the brain is substantial only when prompt treatment hasn’t been received.


 Intraparenchymal hematoma
When blood pools in the brain, intraparenchymal hematoma occurs which is additionally known as intracerebral hematoma. There may be multiple severe intraparenchymal hematomas after a head trauma.
The trauma that results in intraparenchymal hematomas is usually responsible for what are known as white matter shear injuries. These injuries occur after a trauma literally tears axons in the brain’s white matter. Axons are the connections carrying messages or electrical impulses from the neurons in the brain to the rest of the body. When this connection is sheared, serious brain damage can result because the neurons can no longer communicate.
Intrapaenchymal hematoma doesn’t only result in trauma. For instance, the following may also result:

 

 

  • Brain tumors
  • Use of blood thinners
  • Drugs like amphetamines or cocaine
  • Long-term hypertension
  • Blood vessel disorders, like arteriovenous malformation (AVM) or aneurysm
  • Central nervous system infection like encephalitis
  • Certain autoimmune diseases
  • Neurological conditions, like cerebral amyloid angiopathy
  • Bleeding disorders, such as hemophilia, leukemia and sickle cell anemia

Complications

Complications:

None

Treatments:

Some subdural hematomas don't need to be removed because they're small and produce no signs or symptoms. Diuretic medications may help control brain swelling (edema) after a head injury.


Surgery
However, hematoma treatment often requires surgery. Depending on the characteristics of the hematoma, surgery type may be determined. Surgical options include:


Craniotomy: Large hematomas may need that a section of the skull be opened (craniotomy) to remove the blood.
Surgical Drainage: If the blood is localized and isn't clotting excessively, the doctor may create what's called a burr hole through the skull and then remove the liquid by suction.


Recovery
Anticonvulsant drugs like phenytoin (Dilantin) may be prescribed after surgery, to manage or keep post-traumatic seizures from occurring. These medications are continued as long as a year after the trauma. Anxiety, attention difficulties, sleep problems, headache and amnesia may occur and go on for some time.
Recovery can be prolonged and may be incomplete after an intracranial hematoma. Most recovery occurs within the first six months after the injury in adults. Children often recover faster and more completely than adults do.

Prognosis:

Not Available

Expert's opinion

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