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.
Although head injuries can be minor, An intracranial hematoma is a serious and possibly life-threatening condition that often requires immediate treatment.
Your brain floats within your skull, surrounded by fluid that cushions it from the bounces of everyday movement. But the fluid may not be able to absorb the force of a sudden blow or a quick stop. In these situations, your brain may slide forcefully against the inner wall of your skull and become bruised.
Treating an intracranial hematoma often requires surgery to remove the blood. However, a smaller intracranial hematoma may not require surgery.
Signs and symptoms of an intracranial hematoma may occur from immediately to several weeks or longer after a blow to your head. As time progresses, pressure on your brain increases, producing some or all of the following signs and symptoms:
- Slurred speech or loss of ability to speak
- Pupils of unequal size
- Weakness in limbs on one side of your body
As more and more blood fills your brain or the narrow space between your brain and skull, other signs and symptoms may become apparent, such as:
The cause of intracranial bleeding (hemorrhage) is an injury to the head, often as a result of an automobile or motorcycle accident or a seemingly trivial event, such as bumping your head. Mild head trauma is more likely to cause a hematoma if you're an older adult. There may be no open wound, bruise or other outward sign.
If a hematoma results from the injury to your head, it may occur as a subdural hematoma, an epidural hematoma or an intraparenchymal hematoma.
When to Seek Medical Advice
An intracranial hematoma can be life-threatening. Emergency medical treatment often is necessary.
Seek medical advice after any significant blow to the head in which you lose consciousness or experience any of the signs and symptoms that may indicate an intracranial hematoma. Although symptoms of intracranial hematoma may not be immediately apparent, watch closely for subsequent physical, mental and emotional changes.
In addition, tell a family member or a close friend if you experience any type of head trauma. Because memory loss often is associated with head trauma, you may forget that you even suffered a blow to the head. An alerted friend, family member or work colleague may be more likely to recognize the warning signs and arrange for prompt medical attention if aware of your history.
Tests and Diagnosis
Diagnosing a hematoma can be difficult. 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. The best method to define the position and size of a hematoma is by an imaging technique. These include:
Treatment and Drugs
Hematoma treatment often requires surgery. The type of surgery depends on the characteristics of your hematoma. Options include:
- Perforation. If the blood is localized and isn't clotting excessively, your doctor may create a hole through your skull (perforation) and then remove the liquid by suction.
- Craniotomy. Large hematomas may require that a section of your skull be opened (craniotomy) to remove the blood.
Some subdural hematomas don't need to be removed because they're small and produce no signs or symptoms. Doctors may use medications, such as corticosteroids and diuretics, to control brain swelling (edema) after a head injury.
After surgery, your doctor may prescribe anticonvulsant drugs, such as phenytoin (Dilantin), to control or prevent post-traumatic seizures. Seizures can begin as late as 24 months after the trauma. Amnesia, attention difficulties, anxiety and headache may occur and continue for some time.
Recovery after an intracranial hematoma can be prolonged and may be incomplete. In adults, most recovery takes place within the first six months after the injury. Children usually recover faster and more completely than adults do.
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Information from the National Institutes of Health, November 2008