Intracranial Hemorrhage

Intracranial hemorrhage refers to the bleeding in the brain, which can either be between the skull and brain tissue or within the brain tissue. The bleeding increases the pressure inside and leads to compression of different parts of the brain, which can have symptoms and consequences ranging from headache, vomiting, weakness, numbness, or even death. The blood supply to the brain also gets disturbed due to the bleeding depriving the vital tissues of oxygen and resulting in the death of brain tissue which never regenerates once dead. So, intracranial hemorrhage is a serious medical condition. 

Trauma is the leading cause of intracranial hemorrhage. It mainly results in hemorrhages outside the brain tissue, i.e., between the skull and meninges. For example, epidural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage. It may also cause contusions within the brain tissue and cerebral microhemorrhages.

Causes other than trauma include; hypertension, cerebral aneurysms, cerebral amyloid angiopathy, hemorrhagic conversion of ischemic infarction, dural arteriovenous fistulae, cerebral vasculitis, cerebral venous sinus thrombosis, and mycotic aneurysm.

Your brain is enclosed in the skull and covered by three protective membranes called the meninges: dura mater, arachnoid, and pia mater. Intracranial bleeding is classified according to the location, which can be either be outside (between skull and meninges) or within the brain tissue as described below:

Epidural hemorrhage: It is also known as extradural hemorrhage (EDH) in which the bleeding occurs between the dura mater (the outermost meningeal layer) and the skull. It appears "biconvex" on CT scans. It can be due to the rupture of arteries or veins. The most common artery affected is the middle meningeal artery. EDH is characterized by a lucid interval where a person after being unconscious, regains consciousness for some time before deteriorating further.

Subdural hemorrhage (SDH): This type results from bleeding in the subdural space between the dura and arachnoid mater due to the tearing of the bridging veins. It may develop suddenly or more commonly over hours or days. It is always limited to one side of the brain.

Subarachnoid hemorrhage: This type results from bleeding into the subarachnoid space (space between the arachnoid membrane and the pia mater).

Intracerebral hemorrhage: This refers to bleeding inside the brain either in the brain tissue, or the ventricles (the cavities where the brain’s fluid is produced). 

In the USA, around 2% of head trauma cases are associated with epidural hemorrhage. While 5-25% of people with severe head injuries also have subdural hematomas. 2.5 out of 10,000 people suffer Intracerebral bleeding annually worldwide.

The following risk factors can increase your chances of intracranial hemorrhage:

·         Suffering a trauma with a blow to the head (fall or accident)

·         If you are having co-morbid diseases like hypertension(high blood pressure), high cholesterol, amyloid angiopathy

·         Nicotine, alcohol, and cocaine use

·         If you are taking blood-thinning medicines for other causes

·         Brain tumor

·         Aneurysm in the brain vessels

Following are some of the signs and symptoms of intracranial hemorrhage.

·         Decreased levels of vision affecting one or both eyes

·         Numbness or weakness on one side of the body

·         Severe headache

·         Difficulty in walking

·         Feeling Dizzy

·         Loss of balance and coordination

·         Difficulty in speech

·         Confusion

·         Loss of consciousness

If you or your loved ones experience the above symptoms after a fall or an accident or have known risk factors, you must visit your healthcare provider as intracranial hemorrhage is a medical emergency. The doctors will assess the patient in the emergency department and would advise the following investigations:

CT scan of the head: It is the best initial investigation and can show hemorrhages, bone fractures, and brain injuries. It uses X-ray beams from multiple axes and gives a whole scan of the brain tissues and arteries.

MRI scan of the brain: This procedure uses a strong magnetic field to generate images and evaluate the condition of the tissues. It has a high sensitivity than a CT scan, but it takes a longer time and cost so CTscan is preferred as a first choice in emergency situations.

Magnetic resonance angiography (MRA): This procedure involves the use of a contrast material to be injected into the blood vessel to visualize the arteries of the brain and the neck. It can be used to detect arterial malformations and diseases.

Other supportive tests may include Electroencephalogram, Complete blood count (CBC), Chest X-ray, and a complete vascular study.

Lumbar Puncture: It is the procedure in which fluid in your brain and spinal cord (cerebrospinal fluid) is taken out by a needle inserted in your vertebral column. 

Some other disorders resembling a hemorrhage include;

·         Alcohol-Related Neuropathy

·         Intracranial Epidural Abscess

·         Posttraumatic Epilepsy

·         Spinal Epidural Abscess

·         Transient Ischemic Attack

·         Cardioembolic Stroke

·         Cerebral Venous Thrombosis

·         Herpes Simplex Encephalitis

·         Hydrocephalus

Intracranial hemorrhage has to be treated immediately as it can impede fatal consequences. For most hemorrhages, surgery is required. However, some small and slowly developing hematomas can be managed conservatively.

Surgery: Surgery is required to release the pressure which can be done by burring holes in the skull called burr hole drainage, craniotomy (opening of the skull), or craniectomy ( partial removal of part of the skull).

If the bleeding is mild, a procedure called embolization (of the middle meningeal artery) can be performed.

Supportive treatments may include maintenance of fluid and nutrient provision.

Medications may include medicines for controlling blood pressure, anti-anxiety medicines, anti-seizure medicines, painkillers, stool softeners, etc. 

Hemorrhages can cause severe disability and can even cause death. Death has been estimated to occur in 5–50% of the cases of epidural hemorrhage. 

The best way to prevent an intracranial hemorrhage is to learn about the risk factors and adopt some lifestyle changes to manage them;

·         Reduce fall risks for elderly patients.

·         Use helmets while driving motorbikes and drive carefully.

·         Take regular treatment and follow-ups for diseases like diabetes, hypertension, and hyperlipidemia.

·         Get to know your family history and adopt healthy lifestyle changes from the beginning.

·         Avoid smoking, heavy alcohol drinking, and cocaine.

·         Consume a healthy diet rich in vitamins, minerals, omega-3 fatty acids, and antioxidants. Avoid sugary, fatty, and fried food.

·         Exercise regularly to manage comorbid diseases and stay healthy.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 23, 2023.

References

Intracerebral Hemorrhage – Symptoms, Causes, Diagnosis and Treatments (aans.org)

https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Intracerebral-Hemorrhage#:~:text=Intracerebral%20hemorrhage%20(bleeding%20into%20the,or%20abnormal%20development%20or%20trauma.

Intracranial hemorrhage in coronavirus disease 2019 (COVID-19) patients | SpringerLink

https://link.springer.com/article/10.1007/s10072-020-04870-z