Intracranial Hemorrhage - Types, Symptoms, Diagnosis, Complications, and Treatment

Introduction:

Intracranial hemorrhage (ICH) is referred to as acute bleeding inside the skull or brain. It is a life-threatening medical emergency. Therefore, one must immediately go to the emergency room or call their local emergency telephone number if they suspect themselves or someone they know is having an intracranial hemorrhage.

There are four types of ICH:

• Intracerebral hemorrhage.

• Subarachnoid hemorrhage.

• Epidural hematoma.

• Subdural hematoma.

Epidural Hematoma

A hematoma is an accumulation of blood, in the form of a clot or ball, outside a blood vessel. An epidural hematoma occurs when there is an accumulation of blood between the skull and the outermost layer of the brain. It is typically caused due to a head injury and a skull fracture. The prominent feature of epidural hematoma is high-pressure bleeding. If one experiences an epidural hematoma, they might lose consciousness for a brief while and then recover consciousness.

Subdural Hematoma

A subdural hematoma is an accumulation of blood on the brain surface. It is typically the result of the head rushing forward and stopping, for example, in a car accident. However, it could also be due to abuse in children. This is also an example of the same type of movement a child experiences when being shaken. In older people and people with a history of heavy alcohol use, a subdural hematoma is more common than other intracranial hemorrhages.

Subarachnoid Hemorrhage

A subarachnoid hemorrhage is when bleeding occurs between the brain and the meninges, the thin tissues covering the brain. The most common cause of this condition is trauma, but it can also be caused by rupturing a major blood vessel in the brain. A sudden sharp headache usually precedes subarachnoid hemorrhage. Other typical symptoms include vomiting and loss of consciousness.

Intracerebral Hemorrhage

Intracerebral hemorrhage is when bleeding occurs inside the brain. This is the most common form of ICH accompanied by a stroke. An injury or trauma does not usually cause it.

The sudden onset of neurological deficit is a prominent warning sign of intracerebral hemorrhage. This refers to a problem with the functioning of the brain. The symptoms develop over minutes to hours. They include:

• Headache.

• Nausea.

• Vomiting.

• Difficulty speaking.

• Weakness in one part of the body.

• Decreased consciousness.

• Elevated blood pressure.

Who Is at Risk for Intracranial Hemorrhage?

Most ICHs are caused due to a head injury. Therefore, any activities or lifestyle choices that increase the risk of a head injury can lead to ICH.

Factors that increase the risk include:

• Hypertension.

• Heavy use of alcohol.

• Smoking cigarettes.

• Family history of ICH.

• Usage of some drugs, such as cocaine, amphetamines, and MDMA (often called “ecstasy”).

• Extreme physical exertion.

What Are the Symptoms of Intracranial Hemorrhage?

Depending on the type of ICH, the signs and symptoms may vary, but they usually include:

• Sudden onset of severe headache.

• Headache associated with a recent injury to the head.

• Headache coupled with neck stiffness.

• Mild and longer duration of the headache.

• Drowsiness.

• Confusion.

• Vomiting more than twice in 24 hours.

• Seizure.

• Coma.

ICH in Children:

ICH in a child can be indicative of child abuse. The damage may result from a head blow or shaking of the child. This can lead to the shaken baby syndrome. This is a condition that occurs due to violent shaking leading to severe brain damage in a child.

Other signs that indicate child abuse are:

• Swollen head.

• Vomiting.

• Retinal hemorrhages.

• Unconsciousness.

• Seizure.

• Fractures of arms and legs.

Babies under 12 months of age may develop a soft spot or swollen fontanel.

How Is Intracranial Hemorrhage Diagnosed?

The first step the healthcare provider takes for the diagnosis of ICH is a CT scan of the head. A CT scan can display abnormalities in the brain, such as clots or swelling. The CT scan may not display any indication of ICH. However, if one still has specific symptoms, the healthcare provider may choose to conduct a lumbar puncture, also known as a spinal tap, to examine the fluid that acts as a cushion for the spine and brain.

What Are the Treatments for Intracranial Hemorrhage?

ICH is a fatal medical emergency. Therefore, survival depends on getting immediate treatment.

Surgery may be required to relieve the pressure on the brain. For example, drilling a small hole in the skull helps to release blood. However, preparing a giant hole or removing a piece of the skull may be required to remove a blood clot.

Medications:

The following drugs may be necessary:

• Anticoagulants to reduce blood clots.

• Steroids to reduce swelling.

• Antiepileptic drugs to control seizures.

What Are the Complications Associated With Intracranial Hemorrhage?

An ICH can lead to any of the following complications:

• Headaches.

• Seizures.

• Paralysis.

• Brain development problems in children.

• Dizziness.

• Memory loss.

• Difficulty concentrating.

How Can One Prevent Intracranial Hemorrhage?

Basic preventive measures for intracranial hemorrhage that can help avoid head injuries include the following:

• A helmet must be worn when riding a motorcycle, bike, skateboard, or scooter.

• Always wear a seatbelt.

• If one is older, try to avoid falls.

Conclusion:

Depending on the site and severity of the damage caused by the hemorrhage, as well as the overall health and age of a person, there can be continuing effects from a brain bleed. However, one can regain some of these lost functions over time and with much effort and dedication in rehabilitation (occupational, physical, and speech therapy).

Unfortunately, some people who are severely paralyzed or in a coma after an intracranial or cerebral hemorrhage may require permanent, long-term care usually provided in a nursing home. In addition, many patients do not survive the initial bleeding event depending on the brain bleed's type, location, and extent. The sooner one arrives at the emergency room, the better your chance of survival. The time between the start of symptoms and the start of a bleed and confirmation of a bleed is critical. The earlier a brain hemorrhage is detected, the sooner a decision for the appropriate treatment can be made. Let a healthcare provider determine if one has a brain emergency.