Intracranial hematoma

Diagnosis

Diagnosing an intracranial hematoma can be difficult because people with a head injury can seem fine. But doctors usually assume that bleeding inside the skull is the cause of progressive loss of consciousness after a head injury until proved otherwise.

Imaging techniques are the best ways to determine the position and size of a hematoma. These include:

• CT scan. This uses a sophisticated X-ray machine linked to a computer to produce detailed images of your brain. You lie still on a movable table that's guided into what looks like a large doughnut where the images are taken. CT is the most commonly used imaging scan to diagnose intracranial hematomas.
• MRI scan. This is done using magnetic field and radio waves to make computerized images. During an MRI scan, you lie on a movable table that's guided into a tube.
• Angiogram. If there is concern about a possible aneurysm in the brain or other blood vessel problem, an angiogram might be necessary to provide more information. This test uses X-rays and a special dye to produce pictures of the blood flow in the blood vessels in the brain.

Treatment

Hematomas that are small and produce no signs or symptoms don't need to be removed. However, signs and symptoms can appear or worsen days or weeks after the injury. As a result, you might have to be watched for neurological changes, have your intracranial pressure monitored and undergo repeated head CT scans.

If you take blood-thinning medication, such as warfarin (Coumadin, Jantoven), you may need therapy to reverse the effects of the medication. This will reduce the risk of further bleeding. Options for reversing blood thinners include giving vitamin K and fresh frozen plasma.

Surgery

Hematoma treatment often involves surgery. The type of surgery depends on the type of hematoma you have. Options include:

• Surgical drainage. If the blood is in one area and has changed from a solid clot to a liquid, your doctor might create a small hole in your skull and use suction to remove the liquid.
• Craniotomy. Large hematomas might require that a section of your skull be opened (craniotomy) to remove the blood.

Recovery

Recovery after an intracranial hematoma can take a long time, and you might not recover completely. The greatest period of recovery is up to three months after the injury, usually with lesser improvement after that. If you continue to have neurological problems after treatment, you might need occupational and physical therapy.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Coping and support

Patience is important for coping with brain injuries. Adults will have the majority of their recovery during the first six months. Then you might have smaller, more-gradual improvements for up to two years after the hematoma.

To aid your recovery:

• Get enough sleep at night, and rest in the daytime when you feel tired.
• Ease back into your normal activities when you feel stronger.
• Don't participate in contact and recreational sports until you get your doctor's OK.
• Check with your health care provider before you begin driving, playing sports, riding a bicycle or operating heavy machinery. Your reaction times likely will have slowed as a result of your brain injury.
• Check with your doctor before taking medication.
• Don't drink alcohol until you've recovered fully. Alcohol may slow recovery, and drinking too much can increase your risk of a second injury.
• Write down things you have trouble recalling.
• Talk with someone you trust before making important decisions.