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Intracranial Hemorrhages

What Is an Intracranial Hemorrhage?

Intracranial hemorrhage (ICH) refers to acute bleeding inside your skull or brain. It’s a life-threatening emergency. You should go to the emergency room right away or call 911 if you think you or someone you know is experiencing ICH.

What Are the Types of Intracranial Hemorrhage?

 Type 1

There are four types of ICH:

  • epidural hematoma
  • subdural hematoma
  • subarachnoid hemorrhage
  • intracerebral hemorrhage

Epidural Hematoma

An epidural hematoma occurs when blood accumulates between your skull and the outermost covering of your brain.

It typically follows a head injury. High-pressure bleeding is a prominent symptom. If you have an epidural hematoma, you may briefly lose consciousness and then regain consciousness.

A hematoma is a collection of blood, in a clot or ball, outside of a blood vessel.

Subdural Hematoma

This is a collection of blood on the surface of your brain.

It’s typically the result of your head moving rapidly forward and stopping, such as in a car accident. However, it could also suggest abuse in children, since this is the same type of movement a child might suffer when being shaken.

A subdural hematoma is more common than other ICHs in older people and alcoholics.

Subarachnoid Hemorrhage

This is when there’s bleeding between the brain and the thin tissues that cover the brain, which are called meninges. Subarachnoid hemorrhage tends to run in families.

A sudden, sharp headache usually precedes a subarachnoid hemorrhage. Typical symptoms also include loss of consciousness and vomiting. This type of ICH can be due to alcohol or drug abuse.

Intracerebral Hemorrhage

This is when there’s bleeding inside of your brain. This is the most common type of intracranial hemorrhage that occurs with a stroke. It’s not usually the result of injury.

A prominent warning sign is the sudden onset of neurological deficit, which is a problem with your brain’s functioning. The symptoms progress over minutes to hours. They include:

  • headache
  • difficulty speaking
  • nausea
  • vomiting
  • decreased consciousness
  • elevated blood pressure

Who Is at Risk for Intracranial Hemorrhage?

Risk Factors

Most ICHs are due to a head injury. Any activities or lifestyle choices that put you at risk for a head injury can lead to ICH.

Factors that increase your risk include:

  • a family history of ICH
  • alcohol abuse
  • hypertension
  • cigarette smoking
  • the use of certain drugs including amphetamines and MDMA, which is often called “ecstasy”
  • extreme physical exertion

What Are the Symptoms of Intracranial Hemorrhage?

Symptoms

The signs and symptoms of ICH vary depending on the type, but they usually include:

  • a sudden and severe headache
  • a headache associated with a recent blow to your head
  • a mild and long-lasting headache
  • a headache accompanied by neck stiffness
  • confusion
  • drowsiness
  • vomiting more than twice in 24 hours
  • seizure
  • coma

ICH in Children

ICH in a child can indicate child abuse. The damage may be the result of a blow to the head or by shaking the child. This can lead to shaken baby syndrome, which occurs when violent shaking leads to serious brain damage in a child.

Other signs of child abuse are:

  • swollen head
  • retinal hemorrhages
  • vomiting
  • seizure
  • unconsciousness

Babies less than 12 months old may develop a swollen fontanelle, or soft spot.

Report suspected child abuse right away by calling 911 or 1-800-4-A-CHILD (1-800-422-4453).

How Is Intracranial Hemorrhage Diagnosed?

Diagnosis

The first step your doctor will take to diagnose ICH is a CT scan of your head. A CT scan can show abnormalities in your brain like swelling or clots.

The CT scan may not show any sign of ICH. If the patient is still having symptoms, your doctor may choose to perform a lumbar puncture, or spinal tap, to test the fluid that cushions your spine and brain.

What Are the Treatments for Intracranial Hemorrhage?

Treatment

ICH is a medical emergency. Survival depends on getting treatment right away.

It may be necessary to operate to relieve the pressure on the skull. Drilling a small hole in the skull releases blood. Drilling a larger hole may be necessary to remove a blood clot.

Medications

The following drugs may be necessary:

  • steroids to reduce swelling
  • anticoagulants to reduce clotting
  • anti-seizure medications

What Are the Complications Associated with Intracranial Hemorrhage?

Complications

An ICH can lead to any of following complications:

  • seizures
  • paralysis
  • headaches
  • brain development problems in children
  • memory loss
  • dizziness
  • difficulty concentrating

How Can I Prevent Intracranial Hemorrhage?

Prevention

Basic preventive measures that can help to avoid head injuries include the following:

  • Always wear a helmet when riding a bike, motorcycle, skateboard, or scooter.
  • Always wear your seatbelt.
  • Older persons should try to avoid falls.
  • Call 911 or 1-800-4-A-CHILD (1-800-422-4453) to report suspected child abuse.

What Is the Long-Term Outlook?

Outlook

The outlook depends on the severity of the hemorrhage and how quickly you get medical care. Remember, ICH is a life-threatening condition.

Depending on the severity of the hemorrhage, draining a hematoma can lead to recovery. Physical or occupational therapy is sometimes necessary to help you return to normal activities.

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