An intracranial hematoma is a collection of blood within the skull. The blood may collect in the brain tissue or underneath the skull, pressing on the brain. It's usually caused by a blood vessel that bursts in the brain. It also may be caused by a head injury due to a car accident or fall.
Some head injuries, such as one that causes only a short period of unconsciousness, can be minor. However, an intracranial hematoma is potentially life-threatening. It usually requires immediate treatment. This might include surgery to remove the blood.
Symptoms of an intracranial hematoma may develop right after a head injury, or they may take weeks or longer to appear. There may be a period of time without symptoms after a head injury. This is called the lucid interval.
Over time, pressure on the brain increases, producing some or all of the following symptoms:
Loss of movement, known as paralysis, on the opposite side of the body from the head injury.
As more blood fills the brain or the narrow space between the brain and skull, other symptoms may appear, such as:
An intracranial hematoma can be life-threatening and needs emergency treatment.
Seek immediate medical attention after a blow to the head if you or someone you know experiences:
If you don't notice symptoms right after a hit to the head, watch for physical, mental and emotional changes. For example, if someone seems fine after a head injury and can talk but later becomes unconscious, seek immediate medical care.
And even if you feel fine, ask someone to watch you. Memory loss after a blow to your head can make you forget about the blow. Someone you tell might be more likely to recognize the warning signs and get you medical attention.
The most common cause of an intracranial hematoma is a head injury. A head injury that causes bleeding within the skull may result from motor vehicle or bicycle accidents, falls, assaults, and sports injuries.
If you're an older adult, even mild head trauma can cause a hematoma. This is especially true if you're taking a blood-thinning medicine or an anti-platelet medicine, such as aspirin.
A head injury can cause an intracranial hematoma even if there's no open wound, bruise or other obvious damage.
What happens in the brain to cause bleeding varies based on the type of hematoma. There are three categories of hematoma — subdural hematoma, epidural hematoma and intracerebral hematoma. An intracerebral hematoma also is known as an intraparenchymal hematoma.
A subdural hematoma occurs when blood vessels burst between the brain and the outermost of three protective layers that cover the brain. This outermost layer is called the dura mater. The leaking blood forms a hematoma that presses on brain tissue. A hematoma that gets bigger can cause gradual loss of consciousness and possibly death.
Subdural hematomas can be:
All three types require medical attention as soon as symptoms appear. Prompt medical care may prevent permanent brain damage.
An epidural hematoma occurs when a blood vessel bursts 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 presses on brain tissue. The most common cause of an epidural hematoma is a head injury. This type also is called an extradural hematoma.
Some people with an epidural hematoma remain conscious. But most become drowsy or go into a coma from the moment of injury. An epidural hematoma that affects an artery in your brain can be deadly without prompt treatment.
An intracerebral hematoma occurs when blood pools in the tissues of the brain. An intracerebral hematoma also is called an intraparenchymal hematoma. There are many causes, including:
Intracranial hematomas can be caused by a head injury. Activities that increase the risk of a bad head injury, such as riding a motorcycle or bicycle without a helmet, also raise the risk of an intracranial hematoma.
The risk of a subdural hematoma increases with age. The risk also is greater for people who:
Some conditions also may increase the risk of having an intracerebral hematoma. They include being born with poorly connected arteries and veins, and having a bulging blood vessel in the brain, known as an aneurysm. High blood pressure, tumors and some diseases also increase the risk.
To prevent or minimize a head injury that may cause an intracranial hematoma:
Diagnosing an intracranial hematoma can be a challenge because people with a head injury may seem fine at first. Healthcare professionals usually assume that bleeding inside the skull is the cause of a 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:
Intracranial hematomas that are small and produce no symptoms don't need to be removed. However, 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 medicine, such as warfarin (Jantoven), you may need therapy to reverse the effects of the medicine. This will reduce the risk of further bleeding. Options for reversing blood thinners include giving vitamin K and fresh frozen plasma.
Intracranial hematoma treatment often involves surgery. The type of surgery depends on the type of hematoma you have. Options include:
Recovery after an intracranial hematoma can take a long time, and you might not recover completely. The greatest recovery happens up to six months after the injury, usually with lesser improvement after that. If you continue to have neurological symptoms after treatment, you might need occupational and physical therapy.
Patience is important for coping with brain injuries. The majority of recovery for adults happens 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:
