An intracranial hematoma is a collection of clotted blood that forms inside the skull after an injury. At Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, our neurosurgeons specialize in treating intracranial hematoma. Standard treatment may include expert monitoring and/or surgery for drainage.
A hematoma may put pressure on tissue of the brain, causing injury. Physicians categorize hematomas according to the onset and volume of intracranial bleeding. An acute hematoma may be life-threatening and therefore require emergency treatment. A chronic hematoma, though less immediately dangerous, may necessitate treatment to minimize impact on cognition or mobility. Treating a chronic hematoma may partially restore function or prevent further deterioration.
Intracranial hematomas are sometimes classified by their location:
- An epidural hematoma occurs between the skull and the dura.
- A subdural hematoma occurs between the dura and the brain.
- An intraparenchymal hematoma occurs inside the brain itself. It is also sometimes called an intracerebral hematoma.
In some cases, symptoms of an intracranial hematoma appear immediately after a head injury; in other cases, the onset of symptoms is not until hours, days or even weeks later. Delayed onset is relatively common for subdural hematomas in older individuals.
The following symptoms could indicate bleeding in the brain and/or an intracranial hematoma. Anyone who exhibits one or more of these symptoms after a head injury should receive immediate medical attention.
- Loss of consciousness
- Sudden confusion
- Blurred vision
- Severe headache
- Loss of short-term memory, such as difficulty remembering the events leading up to and during the trauma
- Slurred speech
- Difficulty walking
- Weakness in one side or area of the body
- Pale skin color
- Behavior changes, including irritability
- Blood or clear fluid draining from the ears or nose
- One pupil larger than the other
In addition, medical attention should be sought when there is a deep cut in the scalp or an open wound in the head.
The diagnosis of an intracranial hematoma is made on the basis of a physical examination and imaging tests. During the physical examination, a doctor obtains a complete medical history of the patient and family and discusses the circumstances of the injury.
For the imaging portion of the diagnosis, the doctor may order scans such as:
- Computed tomography scan, also called a CT or CAT scan: Uses a combination of X-rays and computer technology to produce images of horizontal and vertical cross-sections (sometimes called “slices”) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans use X-rays but are more detailed than general X-rays.
- Magnetic resonance imaging (MRI) scan: Uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Intracranial hematomas may occur with moderate or severe injuries to the head, such as those sustained during a motor vehicle accident, a bicycle accident, a fall, or an act of violence.
Some individuals are prone to developing hematomas—especially subdural hematomas—after apparently minor head injuries. Groups at particular risk include those:
- Over the age of 60
- Who abuse alcohol
- Who take blood-thinning medication like aspirin or Warfarin
- Who experience repeated head trauma
Treatment is individualized, depending on the extent of the hematoma and the presence of other injuries. Depending on the severity of the injury, management may include:
- Hospitalization for observation
- Surgery to drain blood and remove the blood clot
Head injury may cause the brain to swell, and since bone of the skull encases the brain, there is little room for expansion. Thus brain swelling causes the pressure inside the skull to increase, which can lead to brain damage. A patient who has a severe head injury may require monitoring to manage increased intracranial pressure (ICP).
Several methods exist for monitoring ICP. One common method is that either in the intensive care unit (ICU) or the operating room, a physician may insert a bolt through the skull into the space between the skull and the brain. A sensor is then inserted into this space and attached to a monitor that gives a constant pressure reading.
If the pressure goes up, doctors can administer immediate treatment–medical, surgical, or both. While the ICP device is in place, the patient will be given medication to stay comfortable. When the swelling has decreased, and there is little chance of additional swelling, the device is removed.