Pediatric Head Injuries

Children keep growing and their brain is still developing. So, injuries sustained by their little brain may have lasting effects.


No age group is exempt from head injuries. However, the cause of head injury varies among age groups and from one region to another. For example, in India, fall from height is common. Whereas in the West, child abuse is the common cause of head injury in children.

Common Causes

Few common causes of head injury among children include:

  • Fall

    From balcony, cot, or while the child learns to walk or is engaged in play.

  • Road Traffic Accident

    Among children, road accidents are more common on the way to school and back.

  • Injury During Birth

    Injuries can happen to the baby’s head when instruments are used to pull th ebaby out of the birth canal or if the baby’s soft skull presses agains the mother’s pelvic bones, while pushing its way out.

  • Child Abuse

    Shaking a child vigorously results in injury to the nerves and blood vessels in the brain, sometime cause tiny bleeds in the brain.

Type of Head Injuries

Even through the injuries in children are the same as that in adults, children present with unique features. The clinicial picture and management are different too. Following are few types of injuries sustained by the pediatric age group:

  • Scalp Injury

    In infants, injury to the scalp is usually sustained during birth, as the child passes through the birth canal. In other age groups, scalp injury is very common during the child’s playtime, mainly due of falls.

  • Fracture

    Fractures are uncommon in children because children’s skull are softer than adults and can mold easily. But when the injury is too severe, two types of fractures may result. Linear or a straight line fracture and depressed fracture, where a small part of the skull gets distorted or deformed, as it tries to mold itself.

  • Hematomas

    A bleed in the brain is known as hematoma. This can occur when a vein or artery is damaged, as a result of head trauma. The bleed can occur above (extradural) or below (subdural) the dura mater (a touch sheath covering the brain), or within the brain (intra cerebral).

  • Contusion

    A bruise on the surface of the brain is known as contusion. When the head goes through a violent movement, the forces cause the brain to move within its enclosure and strike or squeeze itself against the outer covering protecting it. This bruises the brain. Children don’t show symptoms immediately after a contusion. So a careful observation for a delayed deorientation is required.

  • Diffused Brain Swelling

    This condition is 2-5 times more common in children than in adults as a child’s brain is so delicate. This usually happens when any head injury initiates fluid accumulation in the brain and hence brain swelling. Even a mild head injury might result in diffuse brain swelling. A CT scan should be performed to recognize the condition early, for immediate intervention.

  • Diffuse Axonal Injury

    Diffuse means ‘scattered’. Axon is the part of a brain cell that is involved in transferring information within the brain. During a fall or a traffic accident where the child is knocked down by the vehicle, brain shakes vigorously, causing damage to the axons. The injury is scattered across the brain, hence the term ‘diffuse axonal injury’. This often occurs together with a concussion.

Complications due to Pediatric Head Injuries

Disseminated Intravascular Coagulation (Disseminated: widespread, intra: inside, vascular: blood vessel, coagulation: Clotting of blood) is a common complication arising out of head injuries.

The brain tissue is a rich source of thromboplastin, a protein that helps in the clotting of blood. When the brain is injured there is an outpouring of thromboplastin from the brain into the blood. This causes a widespread clotting cascade throughout the body. Small vessels get blocked because of random clots obstructing the flow of blood. This compromises blood supply to various regions.

However in time, all the proteins that help with the clotting process is consumed and deficiency results. When there is deficiency, the opposite happens. There is random bleeding from different sites. Bleeding may be so profuse that it becomes difficult to control. If it is not treated early, this lead death of the child.

To prevent this, all children who sustained severe head injury must be monitored closely and their blood parameters should be measured regularly.


Common symptoms after a head injury are:

  • Vomiting
  • Nausea
  • Headache
  • Vision problems
  • Fits
  • Loss of consciousness
  • Irritability
  • Restlessness
  • Agitation
  • Low heart rate
  • Weakness of one or more parts of the body
  • Difficulty concentrating

Not all symptoms are seen in every child with a head injury. Depending on the type and severity of the condition, symptoms vary.

Some minor traumas don’t present with any symptom. Children return to their play immediately after the hit, but come back with complications later. So, apart from symptoms, further diagnostic investigations are required to evaluate the child and provide appropriate management.


Here are the standard tools used for diagnosing a head injury in a child and possibly its effects:

  • X-Ray

    This is an useful diagnostic tool that shows skull fractures clearly at a Glance. A swelling resulting from head injury can also be appreciated easily appreciated.

  • CT Scan

    To get a detailed view of the brain, a CT scan is required. Minor fractures missed by an X ray can be spotted by a CT scan. Bleeding or changes in brain structure can also be identified using this imaging modality.

  • MRI Imaging

    To get a clearer view of blood vessels and exact location of a bleed, an MRI image is required. Since brain is a soft tissue, minor changes in brain structure can also be easily picked up in an MRI.

Treatment for Pediatric Head Injuries

Treatment to Pediatric Head Injury depends on its type and severity. Minor concussions and contusions can be left untreated and injuries that don’t show up on imaging and don’t produce symptoms can be left without a treatment. As a child’s brain is growing, minor injuries heal on their own in the course of time.

Hematomas that are seen at birth also heal on their own in two weeks. However, large hematomas, fluid accumulation in the brain, brain swelling and expanding fractures need to be addressed immediately.

Medical Treatment

Most of the medical treatment for Pediatric Head Injuries are administered for moving the fluid accumulation from the brain. Nerve protecting medication and drugs that prevent seizures are also given.

Surgical Treatment

Surgical treatment for pediatric head injuries fall in to the following categories:

  • Evacuation of Hematoma: A small hole is drilled into the skull and the accumulated blood is removed.
  • Shunt Placement: When there is brain swelling because of fluid accumulation, a metallic tube is placed in the brain that sucks excess fluid from the brain and directs it to any other space in the body that can absorb the incoming fluid. This relieves the pressure inside the brain and prevents further damage.

Go here for more information on surgical treatment for the ailment

Treatment Window

Recovery of the child with head injury depends on the child’s age at the time of injury, severity of the injury and its location. Early identification of the injury and initiation of appropriate treatment helps to save the child’s brain.

Hemangioma, Vertebral: Tumor of the Blood Vessels in Backbone

Non-cancerous tumors of the blood vessels are called hemangiomas. When they occur in the backbone, they are called vertebral hemangiomas.


When a type of cells in the blood vessels called the endothelial cells grow abnormally, they form a type of tumor called hemangioma. Hemangiomas are non-cancerous (benign). Most of the time, they don’t even cause any symptoms. Often, a hemangioma is discovered accidentally during a CT Scan carried out for some other purpose.

A hemangioma in the backbone is called a vertebral hemangioma. It is usually found in the mid or lower back (i.e. lumber or thoracic) regions. Vertebral hemangiomas are more common in women.

Complication due to Vertebral Hemangioma

When a vertebral hemangioma occurs together with hemangiomas elsewhere in the body, they can create problem by bleeding.

If it is present in pregnant women, the tumor enlarge during the 7th to 9th month and may complicate pregnancy. Even though they usually resolve after delivery, if they are not surgically removed, they most probably recur during the subsequent pregnancies.

Symptoms of Vertebral Hemangioma

Hemangiomas usually do not produce any symptoms. They are often identified during a CT or an MRI scan conducted for some other purpose.

In a rare occasion where a patient with a vertebral hemangioma produces symptoms, they include:

  • Back pain, radiating to the legs
  • Weakness or numbness of muscles

Diagnosis of Vertebral Hemangioma

Here are the standard tools used for detecting and diagnosing a vertebral hemangioma:

  • X-Ray

    As the vertebral hemangioma erodes the bone, a honeycomb like appearnace is seen in the X-Ray

  • CT Imaging

    As the tumor invates the backbone, various changes happen inside. In a CT image, this looks like a polka dot (white dots on black background).

Treatment of Vertebral Hemangioma

There is no medical treatment for hemangiomas. But if the tumor causes pain, a doctor may prescribe medication to temporarily relive the pain.

Surgical Treatment

Embolization, followed by Radical Excision: In embolization, the blood vessels feeding the tumor are sealed by injecting a glue, plastic material or a metallic coil into them. This stops the blood flow to the tumor and ultimately the tumor dies. After the tumor death, the remnant can be removed surgically.

Treatment Window

Since this is a benign tumor, it is treated only when it gives some trouble (like back pain, etc.). Otherwise, the risk of surgery far outweighs the benefits of having the tumor removed.


Hemorrhage is a fancy word for leakage of blood (out of blood vessels). And hematoma is a fancy word for blood clot.

Blood clot in the brain is a nasty thing because it an compress other parts of the brain, affect their blood circulation and kill those brain cells. Blood clots can also stop the blood from reach portions of the downstream brain tissues, resulting in their death.

Based on where they occur, there are three major types of hematomas of the brain:

  • Brain Stem Hematomas

    These are blood clots in the brain stem (tissue at the bottom of the brain, connecting it to the spine). Since brain stem controls many vital life keeping functions (breathing, heart rate, body temperature), brain stem hematoma can be life threatening.

  • Extradural Hematomas

    There is a shrink-wrap like tough tissue surrounding the brain (and the spine). It is called the “dura mater”. Blood clot between the dura mater and the skull is called extradural hematoma. This is usually a result of skull injury. When it is serious, a surgeon usually drills a hole into the skull and release the pressure built up by the blood clot.

  • Subdural Hematomas

    There is a shrink-wrap like tough covering around the brain. It is called the dura mater. Immediately under the dura mater, there is a layer filled with blood vessels. When the head shakes vigorously, as if in an accident, the brain bashes against the dura mater, causing leakage of blood and blood clot underneath the dura mater. This is called subdural hematoma.

Brain Stem Hematoma

Brain stem manages many functions vital to sustaining life. So, blood leakage or blood clot here can be life threatening.


“Brain Stem” is the stem like portion of the brain at its lower most part, where the brain connects with the spinal cord. Brian Stem controls and regulates vital functions like breathing, heart rate, regulation of body temperature, etc. So, a hematoma here can be seriously life threatening.

Brain Stem Hematoma is also known as “Duret Hemorrhate”, after the surgeon who first identified it.

Causes of Brain Stem Hematoma

Here are some of the common causes of hematoma or hemorrhage in the brain stem

  • Head Injuries

    Cuts and bruises over the brain stem during a severe head injury can result in blood leakage (hemorrhage) and blot clotting (hematoma)

  • Neck Fracture

    In an automobile accident, passenger in the front seat can have their head violently bump against the dashboard of the car. This can cause a forward and backward movement of the neck at high force, resulting in the fracture of the neck. Such neck fractures almost always end up causing a brain stem hematoma.

  • High Blood Pressure

    High blood pressure can result in rupture of the blood vessels in any part of the body, including the brain stem.

Complication due to Brain Stem Hematoma

Brian stem controls and regulates breathing. As the blood leakage or blood clot in the brain stem worsens, the breathing first becomes irregular, then slows down and ultimately stops. So, patients with a brain stem injury often require external breathing support in the form of a mechanical ventilator.

Symptoms of a Brian Stem Hematoma

Brain stem hematomas usually occur along with brain injuries. Only when the trauma to the brain is so severe, the brain stem is also injured. So, this is a severely debilitating condition. Less than 25% of the patients are conscious when they are brought for medical help. Many of them are:

  • Unconscious
  • Unresponsive
  • Comatose
  • Have shallow/irregular breathing
  • Have increased body temperature

Investigations for a Brain Stem Hematoma

Here are the the most common tool used to diagnose a brain stem hematoma

  • CT Scan

    To identify a brain stem injure, CT Scan is the imaging technique of choice. With the help of a CT, it is possible to identify a brainstem hematoma within 4 to 8 hours of injury.

  • Cold Caloric Response

    In this test, cold water is poured in to the ear. This stimulates a nerve called the vestibular nerve, which connects the base of the brain to the ear. If the brain is functioning well, it responds by sending a signal to the eyes and rapid side to side movement is seen in both the eyes. If the rapid movement of the eyes is not seen, the brain stem is probably not functioning.

  • Brainstem Auditory Evoked Response

    Electrodes are placed under the skin of the scalp, and in front of the ears. A neurosurgeon reads the brain activity through the readings of the electrode. These readings can predict the degree of brain activity.

Treatments for Brain Stem Hematoma

Patients with a brain stem hematoma are very sick. They are likely to remain unconscious for a long period. They need:

  • Longer stay in ICU
  • Proper nursing care
  • Tracheostomy care
  • Management of temperature
  • Management of lung related issues

Medical Treatment

Patients being treated for brain stem hematomas are given medication to decrease the patient’s body temperature, seizure preventing drugs, and nerve protectors.

High dose of antibiotics may also be given to treat infections that may result from tracheostomy, lunc infection, urine infection and general infection.

All of these lead to longer hospital stay.

Surgical Treatment

Surgeries in the brain stem have very low success rate. So, surgeries to remove bleed in the brain stem are not recommended. However, surgeries may be conducted to treat brain injuries in other parts of the brain or to enable artificial breathing through a tracheostomy.

Treatment Window

As mentioned earlier, brain stem hematoma is a life threatening condition. An immediate CT scan, early diagnosis and close follow dramatically increase the survival rate of the patient.

Hematoma Extradural

The brain is a delicate organ. It is protected by a thick outer covering, known as dura mater. A bleed in between the dura mater and the skull is known as an External Hematoma.


Some head injuries result in fracture of the skull bone. This causes separation of the dura mater from the skull it is attached to. The stress results in disruptions of the blood vessels that come in between the dura mater and the skull bone. Thus resulting in an extradural hematoma or a bleed.

Complication of an Extradural Hematoma


Symptoms of Extradural Hematoma

Here are some of the symptoms of an external hematoma:

  • Conscious throughout
  • Unconscious throughout
  • Initially conscious but unconscious few hours later
  • Initially unconscious but later in a dreamy state
  • Weakness in one half of the body
  • Headache
  • Nausea
  • Vomiting

Diagnosing Extradural Hematoma

Here are the standard tools used for diagnosing an external hematoma:

  • X-Ray

    An X-Ray image of the skull shows evidence of a fracture

  • CT Scan

    40% of the time a fracture can be missed on X Ray. As much as possible, an urgent CT is important. In a CT Scan, a fracture is seen much clearer and the bleed is seen as a white patch in the shape of a lens.

  • MRI Imaging

    MRI images can be taken but they are in no way superior to CT in identification of an extradural bleed.

  • Infrared Spectroscopy

    This is a newer diagnostic modality that uses infrared radiation to identify the damaged tissue in the brain within a short span of time.

Treatment of Extradural Hematoma

Minor cases of hematoma are always managed medically. Severe cases need surgical intervention.

Medical Treatment

Small Extradural Hematomas with minimal symptoms can be managed medically with fluid management and nerve protective medications.

Surgical Treatment: Burr Hole

In this surgical treatment of choice for extradural hematoma, a small hole is drilled through the skull and a tube is inserted. Blood is drained out through this tube after which the hole is sutured back.

Go here for more information on burr hole treatmen>

Treatment Window

If the size of an extradural hematoma increases rapidly, or if the condition of the patient worsens clinically, then an immediate surgery is recommended to manage the condition.

Hematomas Intracerebral Traumatic

When a head injury sets off bleeding inside the brain, the blood tends to accumulate and even clot. This is called Traumatic Intracerebral Hematoma.


Intracerebral Hematoma usually happens as a result of closed head injury. Often, this occurs together with other brain injuries like contusion, subdural hematoma or extradural hematoma.

Types of Intracerebral Hematomas

Based on the time lag between hematoma and the injury causing it, Intracerebral Hematomas are divided into two categories.

  • Immediate Type

    A depressed fracture of the skull, or a deep cut (laceration) on the brain following a head injury, results in an immediate intra-cerebral hematoma. These can be minor hematomas when they are caused by rupture of minor blood vessels. Massive bleeds from rupture of large blood vessels is usually common in older age group.

  • Delayed Type

    Delayed hamatomas usually occur in 24 to 48 hours after an injury. These hematomas don’t appear in an brain imaging made immediately after an injury. Delayed hematomas usually happen in patients with weak or diseased blood vessels. Delayed hematomas can be dangerous. They usually need immediate surgical intervention.

Complication due to Traumatic Intracerebral Hematoma

If it is not identified early, an intra-cerebral bleed becomes very dangerous.

  • The bleed can enlarge in size, compressing important structures inside the brain.
  • It can also lead to fluid accumulation in the brain.

All these changes lead to irreversible brain damage and respiratory failure. Coma or worse must be expected if an intra-cerebral hematoma is not attended to immediately.

Symptoms of Traumatic Intracerebral Hematomas

Symptoms of traumatic intra-cerebral hematomas depend on the clinical stage of the condition. The symptoms of the condition worsen with each escalating stage

1: Stage of Initial Compression

In this stage, the hematoma presses upon the surrounding blood vessels, leading to accumulation of fluid inside the brain. Initially, the brain tries to fight against further damage by pushing the excess fluid out of the brain. However, at a point, the natural mechanism is overwhelmed. When this happens, the following symptoms are seen:

  • Brian seizure
  • General irritability
  • Headache, increasing in severity and not relieved with pain medication
  • Vomiting
  • Drowsines
  • Confusion
  • Lack of alertness
  • Paralysis of one side fo the body

2: Stage of Anemia and Neuronal Paralysis

At this stage, the pressure inside the brain rises high enough to cause a decrease in blood flow to the brain. This starts to damage the nerves. Due to internal regulatory mechanisms, more spontaneous bleeding occurs within the brain, which only makes the matters worse. At this stage, the following symptoms are seen:

  • Unconsciousness
  • High blood pressure
  • Irregular breathing
  • Spasm of muscles
  • Stiffening of arms and legs
  • Excessive secretions in the body

3: Stage of Irreversible Neuronal Failure

At this stage, the patient goes into coma. Death may result because the damage to the brain becomes irreversible.

Diagnosis of Traumatic Intracerebral Hematoma

These are the preferred tool to diagnose an intracerebral hematoma

  • CT Imaging

    This is the first step to identify a hematoma in the brain. Repeated CT images at frequent intervals help the physician to spot out hematomas that grow in size with time.

Treatments for Traumatic Intracerebral Hematoma

Patients with small bleed, with no prominent symptoms are managed non-surgically. However repeated CT imaging and close monitoring are required to ascertain the effectiveness of the medical treatment.

Medical Management

Nerve protecting medications and pain relievers are given to patients with intracerebral hematomas. In some patients with previous history of seizures, medication to prevent seizures are also given.

Surgical Treatment

In major cases of intracerebral hematomas, couple of surgical techniques can be used to make the symptoms improve

Craniotomy and Evacuation of the Bleed

In this procedure, a part of the skull is removed and blood inside the brain is scooped out.

Decompressive Craniectomy

In this procedure, part of the skull is removed to release the pressure inside the brain. The brain heals itself and further compression of important structures can be prevented.

Hematoma Subdural

The brain is a delicate organ. It is protected by a thick outer covering, known as dura mater. A bleed, in the space beneath the dura mater is known as a subdural hematoma.


When the head lands against a hard object, small vessels below the dura mater are injured, causing a bleed, leading to a hematoma.

A hematoma often occurs along with a brain contusion. Men are two to four times more likely affected than women.

Complication due to Subdural Hematoma

A subdural hematoma can expand or compress important structures in the brain, sometimes causing death of certain brain tissues.

Another complication is its tendency to cause fluid accumulation in the brain. This leads to brain swelling and increased pressure within the brain. This is a serious complication as it can lead to coma or death when it is not treated early.

Symptoms of Subdural Hematoma

Symptoms depend on the severity of the bleed. Here are the typical symptoms of a subdural hemotam, listed in the order of escalating severity:

  • Headache
  • Nausea
  • Vomiting
  • Stiffness of neck
  • Changes in gait
  • Loss of balance
  • Seizures
  • Weakness in one half of the body
  • Unconsciousness
  • Coma

Diagnosis of Subdural Hematoma

Here is the list of typical tools used for diagnosing an incident of Subdural Hematoma:

  • CT Scan

    On CT scan, a subdural bleed appears as a whitish patch, with a crescent shape. The presence of contusions in other parts of the brain and any fluid accumulation can also be identified in a CT scan.

  • MRI Scan

    A MRI is very quick in taking pictures of the brain (in an irritable, restless patient with head injury, a CT can give erroneous results as the patient moves). Moreover, an MRI can easily pick up even small contusions and bleed, which may be missed on a CT. However, if the patient is known to have metallic implants inside the body, an MRI should be avoided.

  • Radionuclide tracers

    There is a specialized CT imaging technique in which certain harmless radionuclide chemicals are injected through the vein. This enters the blood vessels in the brain and helps the surgeon clearly visualize the blood flow inside the brain.

Treatment of Subdural Hematoma

Small hematomas can be left untouched. They heal on their own in time. Hematomas that cause swelling of the brain can first be treated with medications. But, hematomas that keep growing in size, and that do not respond to medications, need surgical intervention.

Medical Treatment

Drugs that take away fluids from the brain and drugs that maintain the blood pressure are the main stay of treatment for hematoma. Other than that, nerve protective medications are also given.

Surgical Treatment

Surgical treatments for subdural hematoma fall into two categories:

  1. Decompressive Hemicraniectomy: With this surgery, a small portion of skull above the area of bleed is remove. This relieves the pressure inside the brain. The damaged tissue in the brain is allowed to heal without getting squeezed inside the skull. Often, when the skull is opened, the surgeon also sucks out the bleed.
  2. Craniotomy with or without Duraplasty: Under this procedure, a large opening is made in the skull and the hematoma is evacuated. Any point of bleed is burnt using controlled heat. Once the bleed is removed, the dura mater is repaired using a muscle path and the skull is closed.

Treatment Window

Large, expanding hematomas can compress on vital blood vessels in the brain, leading to death of the brain tissue in the affection part of the brain. So, a subdural hematoma must be identified and treated early before complications arise.


Ongoing bleeding, which is blood escaping from the circulatory system of the body, is called a hemorrhage.

Internal hemorrhage is where the blood escapes inside the body either due to rupture of a blood vessel or due to damage or infection to an internal organ.

An external hemorrhage is bleeding on the outer surface, which usually happens due to damage to the skin and the tissue underneath.

Anyone can easily lose 10% to 15% of blood without serious medical complications. While donating blood, one typically gives away about 8% of the circulating blood.

A hemorrhage can occur in any part of body. But at Chennai Neuroscience Foundation, our special interest is in the hemorrhage in the head and spine.

They typically fall into the following category:

  • Intracerebral Hemorrhage

    This is bleeding within the brain tissue, usually caused by ruptured blood vessels in the brain or a bleeding disorder.

Hemorrhage Intracerebral Spontaneous

An ongoing bleeding is called a hemorrhage. Sometimes, this can suddenly occur in the brain. It is called a “Spontaneous Intracerebral Hemorrhage”.


Hemorrhage is an ongoing bleeding. When the bleeding has already happened, it is called a hematoma.

Hemorrhage in the brain causes the blood to seep into the brain tissue, causing many inflammatory reactions to take place. This ultimately interrupts the blood flow to some parts of the brain. This leads to a condition called stroke, where brain tissue starving blood supply starts to die out and corresponding brain function is suddenly lost. Such loss of function an be permanent or temporary.

This condition, called a Spontaneous Intracerebral Hemorrhage, accounts for 10-30% of all stroke cases. However, the leading cause of stroke is blockage of blood vessels by blood clot, fat, etc.

Causes of Spontaneous Intracerebral Hemorrhage

Here are the common causes of Spontaneous Intracerebral Hemorrhages

  • High Blood Pressure

    A sudden uncontrollable increase in blood pressure can cause arteries to burst, leading to a hemorrhage. This can also happen to the arteries in the brain. Patients who often skip their blood pressure medication are at an increased risk for this type of event.

  • Weak Blood Vessels

    Blood vessels weakend by normal aging and other causes can sometimes expand like a balloon. These blood vessels are always in the verge of bursting anytime, leading to a hemorrhage.

  • Trauma

    Severe head traumas (injuries) can lead to bleeding inside the brain.

  • Bleeding Disorders

    Patients with bleeding disorders like hemophilia are very prone to intracerebral hemorrhage. This can happen due to reasons like minor head injuries, uncalibrated consumption of blood thinners, etc.

Complication due to Spontaneous Intracerebral Hemorrhage

If left untreated, an intracerebral hemorrhage can grow in size, leading to injury and swelling (inflammation) of the brain. It leads to extensive damage and death to the brain tissue.

If the treatment is delayed, damage to the brain tissue becomes irreversible. Based on the part of the brain tissue affected, the patient can lose speech, movement control, weakness of limbs, paralysis, etc.

Symptoms of Spontaneous Intracerebral Hematomas

Common symptoms of intracerebral bleed are:

  • Severe Headache
  • Vomiting
  • Increased blood pressure
  • Altered level of consciousness
  • Sudden loss of function in one part of the body
  • Seizure
  • Confusion
  • Trouble with vision

Tools to Diagnose an Intracerebral Hemorrhage

These are the standard tools to diagnose and further investigate an intracerebral hemorrhage:

  • CT Scan

    This is the best imaging modality to confirm the presence of intracerebral hemorrhage. By frequently making CT images of the injured portion, doctors can also ascertain growth in hemorrhage, if any.

  • MRI Imaging

    An MRI is as sensitive as CT in detecting a bleed. It also helps to locate abnormal blood vessels, bleeding tumors, blood vessel obstructions, etc.

  • Angiography

    This is a more sensitive tool to diagnose blood vessel abnormalities. When a patient comes up with no obvious causes for a bleeding, the doctor may order for an angiography.

Treatment for Intracerebral Hemorrhage

Here are the standard treatments for a intracerebral hemorrhage.

Medical Treatment

All intracerebral patients with high blood pressure are treated to bring it down. Additional medication is also given to reduce the pressure within the brain and to divert fluid out of the brain.

Additionally, these patients may also be given supplements containing Vitamin K, which helps to stop bleeding.

Lastly, as an additional precaution, seizure control medication is given to these patients at least for a month following a hemorrhaging event.

Surgical Treatment

There are two common surgical treatments to manage an intracerebral hematoma

Decompressive Craniotomy

This technique is most helpful to treat an intracerebral bleed. In this technique, the skull is opened with special equipment and the leaking blood is drained out. Bleeding points are also identified and the bleeding is arrested using controlled heat. Go to this page to learn more about decompressive craniotomy.

Endoscopic Aspiration

Specilized flexible tubes are inserted into the brain. A camera is attached at the end of this tube, which helps the surgeon to identify the exact bleeding point and suck the bleed out.

With the help of specialized fine flexible tubes inserted into the brain, small bleeds are effectively sucked out. A camera

Treatment Window

If surgical intervention happens within 4 hours of the bleed, there are high chances of re-bleeding.

However, if an attempt is made to remove the bleed within 12 hours, particularly when it is performed using less invasive techniques like endoscopy, there are high chances of an improvement of the condition.

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