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
- 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:
- 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.
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.
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.
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.