Intracerebral HematomasTraumatic  

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.

Intracerebral Hemorrhage 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.

Intracranial Aneurysms Multiple

Weak blood vessels in the brain tend to balloon at the points of their weakness. This is called an aneurysm.


Sometimes, weak blood vessels in the brain can bulge out like a balloon, causing a condition called aneurysm. When an aneurysm ruptures, it spills the blood it carries in to the brain, causing a life threatening condition.

About 1 in 50 people are thought to have an unruptured aneurysm. When an aneurysm ruptures, it can kill 40% of the people in whom the rupture occurs.

Causes of Aneurysm

Here are some common causes that lead to aneurysm:

  • High Blood Pressure

    The presence of high blood pressure weakens the blood vessel walls and make it vulnerable to bulging under any kind of stress or uncontrollable increase in blood pressure.

  • Smoking

    Smokers, particularly the ones who have been smoking for years, end up with their blood vessels weakening, making them susceptible for formation of aneurysm.

  • Blood Vessel Abnormalities

    When malformed blood vessels face any kind of internal stress, they can lead to formation of aneurysms.

  • Hereditary

    In some cases, aneurysm runs in the family. These patients are usually affected by aneurysm at a much younger age.

  • Congenital Disorders

    Some disorders that are present since birth are known to be associated with multiple brain aneurysms.

  • Gender

    When women hit menopause, the level of estrogen in their blood drops. This drop in estrogen makes them vulnerable for aneurysm.

Complication due to Aneurysm

The single most critical complication of aneurysm is rupture. Rupture of an aneurysm is dangerous to life. It can lead to irreversible brain damage and death.

Symptoms of Aneurysm

Small aneurysms rarely produce any symptoms. However, a large aneurysm may press upon important structures in the brain, causing symptoms like

  • Headache
  • Vision problems
  • Nausea
  • Weakness
  • Speech disturbance

If the aneurysm bursts, the patient may immediately fall unconscious and/or present with the following:

  • Sudden and severe headache
  • Sudden loss of vision
  • Sudden paralysis
  • Vomiting
  • Nausea
  • Stiffness of the neck
  • Seizures

Diagnosis of Aneurysm

These are the common tools used for diagnosing the presence of aneurysm

  • Angiography

    This is the best imaging modality for visualizing abnormally dialated blood vessels.

  • CT Imaging

    A CT Image plays an important role in localizing the site of rupture of an aneurysm.

  • MRI Imaging

    An MIR also helps to locate the exact site of aneurysm and to identify any bleed in the brain that occurs due to a ruptured aneurysm. Fluid accumulation in the brain can also be appreciated with the help of an MRI.

Treatment of the Aneurysm

Following are the treatment options available for aneurysm

Medical Treatment

There are no medical management options available for aneurysm. The best that can be done is to put the patient on pain relievers till they are surgically managed.

Surgical Treatment

There are two treatment choices available for aneurysm: Clipping and Coiling

Aneurysm Clipping

In this procedure, the skull is opened and the bulging blood vessel is identified. After identifying the vessel, the surgeon clips it just below the aneurysm, thereby preventing the aneurysm from rupturing.

Coiling of an Aneurysm

This is a minimally invasive procedure in which a catheter (tube) is into an artery at the groin. The tube is gently pushed forward till such time it reaches the blood vessel with the ballooning. At the site of the ballooning, a coil is inserted and the catheter is removed. Blood clot forms around the coil, which in turn heals the aneurysm.

Treatment Window

If an aneurysm is identified and the patient is symptomatic, immediate intervention is warranted so as to fix it before the aneurysm ruptures.

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