Definition

When a blood vessel splits within the brain or between the brain and the skull, an intracranial hematoma occurs. The hematoma (collection of blood) is squeezing the brain tissue. This condition might happen when the fluid around the brain cannot absorb the force of a sudden blow or a quick stop. The brain may forcefully slide towards the inner wall of the skull and thus became bruised. Some head injuries, such as concussion, can me minor, however an intracranial hematoma is dangerous condition that often calls for immediate treatment. Usually, a surgery is needed in order to remove the hematoma.

 

Symptoms

The symptoms of intracranial hematoma can appear immediately after a blow to the head or they can show after few weeks or even longer. There is a period called the lucid interval, when a person seems fine after a head injury, but with time the pressure to the brain increases, so the following signs and symptoms appear:

  • Faintness and nausea
  • Headache that is getting stronger
  • Confusion
  • Unclear speech
  • Unequal pupils
  • Loss of consciousness that is progressing
  • Increased blood pressure

As the level of the blood filling the brain or the space between the brain and the skull is increasing, more symptoms are evident:

  • Unconsciousness
  • Seizures
  • Apathy

 

Causes

The most common causes of intracranial bleeding, i.e. hemorrhage are almost all kinds of accidents, falls and sports injuries in which a person can hit the head. A serious injury can happen even if there is no open wound, bruise or any visible sign.

A hematoma can occur as: subdural, epidural or intraparenchymal

Subdural hematoma happens when blood vessels, mostly veins, split between the brain and the remotest of the three membrane layers that cover the brain (dura mater). Then, from the leaking blood, a hematoma that compresses the brain tissue is formed.  If the hematoma enlarges progressively, a decline in consciousness appears that can result with death.

There are three kinds of subdural hematoma:

  • Acute-the most dangerous kind that is normally caused by a severe head injury and symptoms are evident immediately.
  • Subacute-symptoms develop through time (days or weeks after the injury)
  • Chronic-result of less severe head injury that causes much slower bleeding and symptoms can show after weeks (the patient might not remember the injury)

In order not to result in permanent damage of the brain, an early medical help is required for all the three kinds of subdural hematoma.

Epidural hematoma or extradural hematoma is a kind of hematoma that occurs when an artery splits between the outer surface of the dura mater and the skull. Then, blood leaks between the dura mater and the skull and forms a mass which is compressing the brain tissue. Most of the people become sleepy and comatose fright after the trauma. However, some people remain unconscious. Unless a rapid treatment is demanded, the epidural hematoma can be lethal.

Intraparenchymal hematoma, also known as intracerebral hematoma, happens when blood pools are formed in the brain. It might happen, that after a severe head trauma there are multiple dangerous intraparenchymal hematoma. The trauma that is cause by this kind of hematoma often results in torn axons in the white matter of the brain. The axons are responsible to carry the electrical impulses i.e. messages from the neurons the brain to the rest of the body. If this connection is cut off, a serious brain damage can happen.

 

Treatment

Sometimes hematomas are very small and do not produce any signs or symptoms. If the patient doesn’t have a surgery to remove such small hematoma, the condition should be closely watched for any neurological changes, have the intracranial pressure monitored and undergo several CT scans, as the symptoms can appear or become worse even weeks after the injury.

However, the hematoma treatment usually understands a surgery. The type of the surgery can differ. It depends on the characteristics of the hematoma what kind of surgery will the patient undergo. The options can be:

  • Surgical drainage (a hole in the skull is  created and the liquid is removed with suction)
  • Craniotomy (a section of the skull is open in order to remove the blood)

After the surgery a drug treatment continues for up to a year to control and prevent post-traumatic seizures. However, if seizures continue a long-term therapy will be needed.

Some of the conditions may continue for some time after the surgery:

  • Problems sleeping
  • Problems concentrating and paying attention fully
  • Headaches
  • Anxiety
  • Amnesia

If the patient has neurological problems even after the treatment, occupational and physical therapy should be taken into consideration.

 

Prevention

There are few thing that the patient suffering from this kind of disease can make to protect himself/herself:

  • Wear a helmet during an action when a head injury is likely to happen
  • Buckle the seat belt while in the car