Intracranial hematoma

Diagnosis

The diagnosis of intracranial hematoma typically involves an evaluation of physical symptoms and conduct of several tests. Doctors normally presume that bleeding inside the skull is the cause of increasing loss of consciousness following a head injury. However, it can sometimes be difficult since people who have had a head injury may appear normal or show no symptoms.

The most effective method to confirm and determine the location and size of a hematoma is through imaging tests, such as:

• Computed tomography (CT) scan: This is the most utilized imaging scan to diagnose intracranial hematomas. A CT scan creates images of a cross-section of the body using X-rays and computers. This procedure produces detailed images of the brain beneficial to confirm the diagnosis.
• Magnetic resonance imaging (MRI) scan: Since MRI does not use X-rays or other forms of radiation, it is the imaging test of choice when people require regular imaging for diagnosis or treatment monitoring, particularly of the brain. To get extremely detailed images, this painless procedure employs a huge magnet, radio waves, and a computer.
• Angiogram: This test uses X-rays plus a specific dye to obtain images of blood flow in brain arteries. An angiography may be required to provide further information if there is a suspected aneurysm in the brain or other blood vessel disease.

Treatment

The cause of intracranial hematoma should be identified so that the appropriate treatment can be given. Signs and symptoms can arise or intensify days or weeks after the injury. The patient may be required to undergo neurological monitoring, intracranial pressure monitoring, and frequent head CT scans. On the other hand, mild hematomas that cause no signs or symptoms may not require treatment.

Effects of blood-thinning medications may need to be reversed to reduce the possibility of additional bleeding. Giving vitamin K and fresh frozen plasma are two options for reversing blood thinners.

• Surgery: Bleeding may necessitate rapid brain decompression to remove collected blood and relieve pressure. Surgery may be recommended to treat the hematoma. Surgical options include:
  • Surgical drainage: A burr hole procedure or drilling a hole in the skull to allow blood drainage may be performed. The doctor may need to suction the liquid out especially if the blood is concentrated in one location and has transformed from a solid clot to a liquid.
  • Craniotomy: To decompress the brain, opening the skull cavity may be necessary. This is often recommended in massive hematomas. A craniectomy incision or partial removal of the skull to allow the swollen brain to expand may be performed in some cases.
• Recovery: The most significant period of healing is up to three months following the injury, with less progress beyond that. With time and dedication to rehabilitation activities such as physical, occupational, and speech therapy, some of the lost functions can be restored. This is especially true if one’s overall health is good.
  Generally, recovery from an intracranial hematoma might take a long period, and one may not fully recover. Some patients who stay in a coma or have been badly paralyzed as a result of an intracranial or cerebral hemorrhage may require long-term care in a nursing facility.