Intracranial Hematoma

A blood clot inside the skull is called an intracranial hematoma. This blood can pool in the brain itself or between the brain and the skull, putting pressure on the brain tissue. This usually happens when a blood vessel in the brain bursts. A bump or injury to the head, like from a car crash or a fall, can also cause a hematoma.

Some head injuries are minor, only causing a brief loss of consciousness. However, an intracranial hematoma is a serious medical condition that can be life-threatening. It typically needs immediate medical attention. Treatment often involves surgery to remove the blood clot and relieve the pressure on the brain.

A brain bleed (intracranial hematoma) can cause a variety of symptoms, sometimes appearing right after a head injury or taking weeks to develop. There might be a period of time with no symptoms after the injury, called a "lucid interval." This is because pressure builds up inside the skull as the bleed gets larger. This increasing pressure can lead to several problems:

Early Symptoms (often developing gradually):

• Headache: A headache that gets progressively worse over time.
• Nausea and Vomiting: Feeling sick to your stomach and throwing up.
• Drowsiness and Loss of Consciousness: Feeling sleepy and gradually losing awareness.
• Dizziness: Feeling lightheaded or unsteady.
• Confusion: Difficulty thinking clearly or remembering things.
• Unequal Pupils: One pupil in your eye is larger or smaller than the other.
• Slurred Speech: Difficulty speaking clearly.
• Paralysis: Loss of movement on the side of the body opposite to the head injury.

Later Symptoms (as the bleed worsens):

• Extreme Sleepiness or Lethargy: Feeling very tired and sluggish.
• Seizures: Sudden, uncontrolled muscle contractions.
• Loss of Consciousness: Losing awareness completely.

A brain bleed is a serious medical emergency and needs immediate attention. Seek urgent medical care if you or someone you know experiences any of the following:

• Loss of consciousness (even briefly): This is a crucial sign.
• Persistent headache: A headache that won't go away.
• Vomiting: Repeated vomiting.
• Weakness: Feeling weak in any part of your body.
• Blurred vision: Problems seeing clearly.
• Trouble staying steady (dizziness): Having difficulty keeping your balance.

Important Note: If you don't notice symptoms immediately after a head injury, pay close attention to any changes in your physical, mental, or emotional state. Even if someone seems fine initially, but later becomes unconscious or confused, get immediate medical help. If you're unsure if you're okay, ask a friend or family member to monitor you. Memory loss after a head injury can make you forget about the injury, potentially delaying seeking help. Having someone else aware of the situation can increase the likelihood of getting the necessary medical attention.

A brain bleed (intracranial hematoma) is a serious injury that needs immediate medical care.

Get help right away if you or someone you know has been hit on the head and experiences any of these:

• Passing out (losing consciousness): This is a very serious sign.
• Persistent headache: A headache that won't go away, or gets worse.
• Upset stomach (vomiting), feeling weak, blurry vision, or trouble walking straight: These are all possible signs of a brain bleed.

Sometimes, the symptoms of a brain bleed don't appear right after the injury. Pay close attention to any changes in the person's physical, mental, or emotional state. For example, someone might seem okay after a head injury, talking normally, but then later become unconscious. This is a clear sign that they need immediate medical help.

Even if you feel completely fine after a head injury, ask someone to watch you closely. A brain bleed can cause memory loss, making you forget that you were hurt. Having a friend or family member keep an eye on you can help them notice warning signs and get you the medical attention you need.

A brain bleed, also known as an intracranial hematoma, is a serious condition often caused by a head injury. This injury can happen in many ways, including car accidents, bike crashes, falls, physical assaults, and sports. Even a seemingly minor head bump can be problematic, especially in older adults or those taking blood-thinning medications like aspirin. This is because these medications can make the blood more likely to clot. Bleeding within the skull can occur without any visible wound, bruise, or other obvious sign of damage.

The brain has three protective layers. A hematoma happens when a blood vessel bursts and leaks blood between these layers. The exact location of the bleed determines the type of hematoma. There are three main types:

• Subdural Hematoma: This happens when a blood vessel breaks between the brain and the outermost protective layer (dura mater). The leaking blood creates a swelling (hematoma) that puts pressure on the brain tissue. This pressure can lead to a gradual loss of consciousness and potentially death if left untreated. Subdural hematomas can be acute (severe, immediate symptoms after a major injury), subacute (symptoms appear days or weeks later after a head injury), or chronic (symptoms take weeks or months to appear after a minor injury). Chronic subdural hematomas can be caused by seemingly minor bumps, especially if you're taking blood thinners. It's important to seek medical attention for any head injury, even if you don't feel sick right away.

• Epidural Hematoma: This type of bleed occurs between the dura mater and the skull. A blood vessel rupture leads to blood pooling in this space, putting pressure on the brain. This is often caused by a head injury, frequently a more severe one. Some people may stay conscious for a while, but many lose consciousness or become drowsy immediately after the injury. If an artery is involved, this type of hematoma can be life-threatening if not treated quickly.

• Intracerebral Hematoma (or Intraparenchymal Hematoma): This type of bleed occurs within the brain tissue itself. Causes can vary, including: head injuries (which can cause multiple bleeds), a burst blood vessel (aneurysm), birth defects in blood vessels, high blood pressure, or tumors. Some diseases can also cause sudden bleeding into the brain.

Regardless of the type, any intracranial hematoma requires immediate medical attention. Prompt treatment can significantly reduce the risk of permanent brain damage.

Head injuries can cause bleeding inside the skull, called an intracranial hematoma. Activities that put you at risk for serious head injuries, like riding a motorcycle or bicycle without a helmet, also increase your chances of getting this type of bleeding.

Getting an older age also makes you more likely to develop a subdural hematoma (a specific type of intracranial bleeding). Other factors raise the risk too:

• Taking blood thinners: If you regularly take aspirin or similar medications, your blood clots more slowly. This means your risk of bleeding increases.

• Alcohol problems: People with alcohol use disorder are at higher risk for head injuries and, therefore, for intracranial hematomas.

• Certain medical conditions: Some people are born with blood vessel connections that aren't working properly, increasing the risk of bleeding in the brain. A bulge in a blood vessel (an aneurysm) can also weaken the vessel and cause bleeding. High blood pressure, brain tumors, and some diseases can also make you more vulnerable to intracranial hematomas.

In short, several factors can make you more susceptible to bleeding inside your skull. If you are concerned about your risk, talk to your doctor.

Head injuries, including brain bleeds (intracranial hematomas), can be serious. Here's how to protect yourself and your kids:

1. Wear Protective Gear: Wearing a helmet is crucial for activities that could lead to a head injury. This includes sports like football or hockey, but also activities like biking, skateboarding, snowboarding, and even motorcycling. Make sure the helmet fits snugly and is the right size for the person wearing it. Children need age-appropriate helmets.

2. Buckle Up: Whenever you're in a car, whether driving or riding as a passenger, always fasten your seatbelt. This simple step can significantly reduce the risk of head injury in a crash. Again, make sure children are properly secured in age-appropriate car seats, using the straps and harnesses correctly.

3. Childproofing Your Home: Young children are especially vulnerable to falls and bumps. To keep them safe, take steps to make your home safer. Put padding on sharp edges of tables and countertops. Block stairways with gates, and secure heavy furniture to walls to prevent it from tipping over. Keep children away from unstable objects. Install window guards and gates to prevent falls from stairs or windows. These precautions can help prevent tumbles and injuries.

By following these simple tips, you can significantly lower the risk of head injuries for everyone in your family.

Identifying a brain bleed (intracranial hematoma) can be tricky. Sometimes, people with head injuries seem okay at first, even though there's bleeding inside their skull. Doctors often suspect bleeding as the cause of a loss of consciousness after a head injury, but they need to be sure.

To find out exactly where and how big a brain bleed might be, doctors use special imaging tests. These tests help them pinpoint the problem.

• CT scan: This is like a very detailed X-ray. A powerful X-ray machine, connected to a computer, creates detailed pictures of your brain. You lie still on a table that moves into a large, doughnut-shaped machine. CT scans are the most common way to find brain bleeds.

• MRI scan: This test uses powerful magnets and radio waves to create detailed pictures of your brain. You lie still on a table that moves into a long, tube-like machine.

• Angiogram: If doctors are concerned about a bulge or weakness in a blood vessel (aneurysm) or other blood vessel problems in the brain, they might use an angiogram. This test uses X-rays and a special dye to show the blood flowing through the brain's blood vessels. This helps doctors get a better picture of the blood vessels and any potential problems.

Treating Intracranial Hematomas and Blood Thinners

If you're taking blood-thinning medication like warfarin (Jantoven), your doctor might need to reverse its effects to prevent further bleeding. This can be done by giving you vitamin K or fresh frozen plasma. These substances help your blood clot more easily.

Intracranial hematomas (blood clots inside the skull) often require surgery. The specific surgery depends on the location and size of the clot.

• Surgical Drainage: If the clot is in one area and has become liquid, a small hole might be made in your skull, and a suction device used to remove the fluid.

• Craniotomy: For larger clots, a section of your skull might need to be removed (a craniotomy) to get the blood out.

Recovery from an intracranial hematoma can be a long process, and you might not fully regain all your abilities. Most significant improvement happens within the first six months after the injury, though some gradual progress might continue for up to two years. If you still have problems with thinking, movement, or other functions after treatment, you might need physical and occupational therapy to help you recover.

Be patient with your recovery. Most of the improvements in adults happen within the first six months, but there can be more gradual improvements for up to two years afterward.

To support your recovery:

• Rest: Get plenty of sleep at night and rest during the day when you feel tired. This is crucial for healing.

• Gradual Return to Activities: Slowly return to your normal activities as you feel stronger. Don't try to do too much too soon.

• Avoid High-Risk Activities: Don't participate in contact sports or recreational activities requiring a lot of physical exertion until your doctor says it's okay.

• Check with Your Doctor: Before driving, playing sports, riding a bike, or operating heavy machinery, talk to your doctor. Brain injuries can sometimes affect reaction time.

• Medication Caution: Talk to your healthcare team before taking any new medications.

• Avoid Alcohol: Avoid alcohol until you've fully recovered. Alcohol can slow down recovery and increase the risk of further injury.

• Memory Aids: Write down things you have trouble remembering.

• Seek Support: Talk to someone you trust about important decisions. Having support during this time is vital.

Remember, these are general guidelines. Your individual recovery plan will depend on the specific nature of your injury and your overall health. Always follow the instructions given by your doctor and healthcare team.