What is an intracranial hematoma?
An intracranial hematoma is a collection of blood in the cranial cavity that is usually caused by a rupture of a blood vessel in the brain, which may be caused naturally or due to trauma, such as a fall or a severe blow such as from a car accident.
Intracranial hematoma can be life-threatening and requires immediate treatment to remove the blood that collects under the brain tissue or under the skull, putting pressure on the brain.
Prognosis of intracranial hematoma
There are head injuries that may be mild, such as a concussion, in which the patient may lose consciousness for a short period of time. However, an intracranial hematoma can be life-threatening, as the blood that spills between the skull and the brain or under the brain tissue puts pressure on the brain of the affected person.
Symptoms of intracranial hematoma
Signs and symptoms of intracranial hematoma may be immediate, that is, they appear right after the trauma, or they may take time to appear. Signs may be delayed for days or even weeks – this period is referred to as the lucid interval – although over time the brain pressure will increase, so symptoms will appear sooner or later.
Some of the most common symptoms of intracranial hematoma are the following:
- Headache which gradually increases in intensity.
- Vomiting
- Drowsiness
- Progressive loss of consciousness
- Dizziness
- Confusion
- Slurred speech, slurred speech
- Pupils of unequal size
As more blood flows into the brain or the space between the skull and brain, other symptoms such as seizures, lethargy or unconsciousness may occur.
Medical tests for intracranial hematoma
Diagnosis of intracranial hematoma can be complicated, as the patient may appear to be fine despite having a head injury.
However, loss of consciousness after trauma is linked to a hematoma unless tests indicate otherwise.
Imaging tests are the best way to check if a hematoma exists, where it is and its size. Some are:
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Angiography
CT image of an intracranial hematoma.
What are the causes of intracranial hematoma?
The causes of intracranial hematoma are clear: a head injury is the frequent cause of intracranial bleeding. Injury, which usually occurs from an accident or a fall, is the cause of the hemorrhage.
In case the patient is taking anticoagulants or anti-platelet medications, even a slight trauma can cause a hematoma.
There are three types of hematomas, subdural, epidural and intraparenchymal:
Subdural hematoma
In this case, the blood vessels suffer a rupture between the brain and the dura mater. Blood leaks out, forming a hematoma that presses on the brain tissue. As the hematoma grows, the patient may lose consciousness or even life.
There are three types of subdural hematomas, acute, subacute and chronic.
- Acute: this is the most dangerous and is caused by a severe injury. Signs are immediate.
- Subacute: symptoms take days or weeks to manifest.
- Chronic: lesions are less severe, bleeding is much slower and symptoms are delayed up to months.
The risk of suffering this hematoma increases as the individual ages. People who take aspirin or anticoagulants on a daily basis and/or drink alcoholic beverages in excess are more at risk.
Epidural hematoma
It occurs when a blood vessel -usually an artery- ruptures between the outer surface of the dura mater -membranes that protect the brain- and the skull. The blood leaks, forming a mass that presses on the brain.
The most frequent cause is trauma. It can be fatal if not treated immediately.
Intraparenchymal hematoma
Known as intracerebral hematoma, it occurs when blood accumulates in the brain. It is caused by trauma, aneurysm rupture, vascular malformation, the presence of a tumor or high blood pressure.
Can intracranial hematoma be prevented?
There is no way to prevent the appearance of an intracranial hematoma. However, you can try to minimize or avoid head injuries by doing the following:
- Wearing a helmet
- Fastening seat belts
- Protecting young children
Treatments for intracranial hematoma
Hematomas that are small and do not cause symptoms do not need to be removed. However, signs and symptoms may appear days later or worsen later, so the patient may need to be observed for possible changes.
If the patient is taking anticoagulant medications, he or she may need treatment to reverse the effects of the medication. However, treatment of intracranial hematoma usually requires surgery. Some options are:
- Surgical drainage: in case the blood is localized and does not clot much, the doctor can make a hole in the skull and suction out the fluid.
- Craniotomy: Large hematomas may require opening a portion of the skull to drain the blood.
Recovery from an intracranial hematoma may take time, even extending over several months, and may not be complete. Recovery may be accompanied by occupational therapies and therapeutic exercises.
What specialist treats intracranial hematoma?
The specialist in charge of treating intracranial hematoma is the Neurosurgeon, due to the difficulty of the process.