An intracranial hematoma occurs when a blood vessel ruptures within your brain or between your skull and your brain. The collection of blood (hematoma) compresses your brain tissue.

An intracranial hematoma may occur because the fluid that surrounds your brain can't absorb the force of a sudden blow or a quick stop. Then your brain may slide forcefully against the inner wall of your skull and become bruised.

Although some head injuries — such as one that causes only a brief lapse of consciousness (concussion) — can be minor, an intracranial hematoma is potentially life-threatening and often requires immediate treatment.

An intracranial hematoma often, but not always, requires surgery to remove the blood.

Signs and symptoms of an intracranial hematoma may be evident right after a blow to your head, or they may take several weeks or longer to appear. You may seem fine after a head injury, a period called the lucid interval. However, with time, pressure on your brain increases, producing some or all of the following signs and symptoms:

  • Increasing headache
  • Vomiting
  • Drowsiness and progressive loss of consciousness
  • Dizziness
  • Confusion
  • Unequal pupil size
  • Slurred speech
  • Increased blood pressure

As more blood fills your brain or the narrow space between your brain and skull, other signs and symptoms may become apparent, such as:

  • Lethargy
  • Seizures
  • Unconsciousness

When to see a doctor

An intracranial hematoma can be life-threatening. Emergency medical treatment often is necessary.

Seek immediate medical attention after a blow to the head if:

  • You lose consciousness
  • You have any of the signs and symptoms that could indicate an intracranial hematoma

Signs and symptoms of intracranial hematoma may not be immediately apparent, so watch for subsequent physical, mental and emotional changes. For example, if someone seems fine after a blow to the head and can talk but then becomes unconscious, seek immediate medical care.

Also, even if you feel fine, ask someone to keep an eye on you. You may have memory loss after a blow to your head, so you may forget about it eventually. Someone you tell may be more likely to recognize the warning signs and get you prompt medical attention.

The cause of intracranial bleeding (hemorrhage) usually is a head injury, often resulting from automobile, motorcycle or bicycle accidents, falls, assaults, and sports injuries. Mild head trauma is more likely to cause a hematoma if you're an older adult, especially if you're taking an anticoagulant or antiplatelet drugs, such as aspirin. You can have a serious injury even if there's no open wound, bruise or other outward sign of damage.

A hematoma may occur as a subdural hematoma, an epidural hematoma or an intraparenchymal hematoma.

Subdural hematoma

This occurs when blood vessels — usually veins — rupture between your brain and the outermost of three membrane layers that cover your brain (dura mater). The leaking blood forms a hematoma that compresses the brain tissue. If the hematoma keeps enlarging, a progressive decline in consciousness occurs, possibly resulting in death.

The three types of subdural hematomas are:

  • Acute. This type is the most dangerous. It's generally caused by a severe head injury, and signs and symptoms usually appear immediately.
  • Subacute. Signs and symptoms take time to develop, sometimes days or weeks after your injury.
  • Chronic. The result of less severe head injuries, this type of hematoma may cause much slower bleeding, and symptoms can take weeks to appear. You might not recall injuring your head.

All three types require medical attention as soon as signs and symptoms appear, or permanent brain damage may result.

The risk of subdural hematoma is greater for people who:

  • Take aspirin or anticoagulants daily
  • Abuse alcohol
  • Are elderly

Epidural hematoma

Also called an extradural hematoma, this type 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 to form a mass that compresses the brain tissue.

Some people with this type of injury remain conscious, but most become drowsy or comatose from the moment of trauma. An epidural hematoma that affects an artery in your brain can be deadly unless you get prompt treatment.

Intraparenchymal hematoma

This type of hematoma, also known as intracerebral hematoma, occurs when blood pools in the brain. After a head trauma, there may be multiple severe intraparenchymal hematomas.

The trauma that causes intraparenchymal hematomas often is responsible for so-called white matter shear injuries — torn axons in the brain's white matter. Axons carry electrical impulses, or messages, from the neurons in the brain to the rest of the body. When this connection is sheared, serious brain damage can result.

Diagnosing an intracranial hematoma can be difficult because individuals may seem fine after an injury. However, doctors generally presume that the progressive loss of consciousness after a head injury is caused by a hemorrhage inside the skull until proved otherwise.

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

  • Computerized tomography (CT) scan. A CT scan 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.
  • Magnetic resonance imaging (MRI) scan. An MRI scan is done using a large magnet and radio waves to make computerized images. During an MRI scan, you lie on a movable table that's guided into a tube, or tunnel. MRIs generally aren't used as often as CT scans in the diagnoses of intracranial hematomas because MRIs take longer to perform and aren't as available.

Some hematomas don't need to be removed because they're small and produce no signs or symptoms. But because signs and symptoms may appear or worsen days or weeks after the injury, if you don't have surgery, you may 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, you may need therapy to reverse the effects of the medication and reduce the risk of further bleeding. Options for reversing blood thinners include administering vitamin K and fresh frozen plasma.

Surgery

Hematoma treatment often requires surgery. The type of surgery depends on the characteristics of your hematoma. Options include:

  • Surgical drainage. If the blood is localized and isn't clotting excessively, your doctor may create a burr hole through your skull and use suction to remove the liquid.
  • Craniotomy. Large hematomas may require that a section of your skull be opened (craniotomy) to remove the blood.

Recovery

After surgery, your doctor may prescribe anticonvulsant drugs for up to a year after the trauma to control or prevent post-traumatic seizures. Long-term anticonvulsant therapy may be needed if seizures continue.

Other conditions that may continue for some time after surgery include:

  • Amnesia
  • Attention difficulties
  • Anxiety
  • Sleep problems
  • Headaches

Recovery after an intracranial hematoma can be prolonged and may be incomplete. If you continue to have neurological problems after treatment, you may need occupational and physical therapy.

Patience is the key to coping with brain injuries. Adults will experience the majority of their recovery during the first six months. You may continue to experience smaller, more gradual improvements for up to two years after the hematoma.

The following tips may help make for a smoother recovery:

  • Get adequate 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 doctor 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 hinder recovery, and drinking to excess can increase your risk of a second injury.
  • Write down things you have trouble recalling.
  • Talk with trusted family or friends before making important decisions.

These steps may help to prevent or minimize head injury:

  • Wear a helmet and make sure your kids wear helmets. Wearing an appropriate and properly fitted helmet when playing contact sports, bicycling, motorcycling, skiing, horseback riding, skating, skateboarding, snowboarding or doing any activity that could result in head injury can help prevent injury.
  • Buckle your seat belt and make sure your kids are buckled in. Doing so anytime you drive or ride in a motor vehicle may prevent or minimize head damage in an accident.
  • Protect young children. Always use properly fitted car seats, pad countertops and edges of tables, block stairways, tether heavy furniture or appliances to the wall to prevent tipping, and keep children from climbing on unsafe or unsteady objects.
Jun. 25, 2014