Diseases & Conditions

Intracranial hematoma

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 isn't 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.

Although head injuries can be minor, an intracranial hematoma is a serious and potentially life-threatening condition that often requires immediate treatment.

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. It's even possible to seem perfectly fine after a head injury. This is called the lucid interval. As time progresses, pressure on your brain increases, producing some or all of the following signs and symptoms:

• Increasing headache
• Vomiting
• Drowsiness and progressive loss of conciousness
• Dizziness
• Confusion
• Pupils of unequal size
• Weakness in limbs on one side of your body
• Increased blood pressure

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:

• 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 any significant blow to the head in which:

• You lose consciousness
• You 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. For example, if someone seemed fine after a blow to the head and was talking to you, but then lapses into unconsciousness, seek immediate medical care.

In addition, tell a family member or a close friend if you've experienced 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.

Some subdural hematomas don't need to be removed because they're small and produce no signs or symptoms. Diuretic medications may help control brain swelling (edema) after a head injury.

Surgery
However, 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 what's called a burr hole through your skull 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.

Recovery
After surgery, your doctor may prescribe anticonvulsant drugs, such as phenytoin (Dilantin), to control or prevent post-traumatic seizures. These medications are continued as long as a year after the trauma. Amnesia, attention difficulties, anxiety, sleep problems 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.