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Intracranial Hematoma

Head injuries account for approximately 70% of traumatic accident deaths. Intracranial hematoma plays an important role in the death and disability that are associated with head injury. Intracranial hematoma is a serious and possibly a life threatening condition that often requires immediate medical attention. Many patients with intracranial hematoma harbor mass lesions that require emergency decompression. Other causes include brain tumors, liver disease, autoimmune syndromes and bleeding disorders.


The human brain floats within the skull. It is surrounded by cerebrospinal fluid which cushions the brain from the bounces of everyday movements. Sometimes it becomes impossible for the fluid to absorb the force of a sudden blow or a quick stop. Under such situations, the brain may slide forcefully against the inner wall of the skull and get bruised. An intra-cranial hematoma occurs when the blood vessel ruptures between the skull and the brain. The blood leaks between the brain and the skull. This collection of blood, hematoma, which is possibly clotted, compresses the brain tissue. Some hematomas require surgery to remove the blood clot whereas some others can be treated without surgery.


Symptoms of intracranial hematoma include headache, nausea, vomiting, lethargy and slurred speech. The pupils may appear of unequal size. Memory loss is often associated with head trauma. One may even forget that they have suffered a blow. These symptoms of intracranial hematoma may occur either immediately or several weeks or months after a blow has been received in the head.


Injury in the head is the most common cause of intracranial hematoma. Among elderly persons, even a mild head trauma is more likely to cause a hematoma in the brain. Hematoma resulting from injury in the head is classified as:


Subdural hematoma: This occurs when the blood vessels, most often the veins rupture between the brain and the dura mater which is the outermost of three membrane layers that covers the brain. The blood that leaks forms a hematoma. This compresses the brain tissue. The danger here is that if the hematoma keeps growing then there is a progressive decline in consciousness and possible death. The risk of subdural hematoma is greater in people who use aspirin or other anticoagulants regularly. Alcoholics and very young and very old people also stand to be affected by subdural hematoma. All types of subdural hematomas require medical attention as soon as the symptoms become apparent. Other wise permanent brain damage may be the result.


Epidural hematoma: This type of hematoma occurs when the blood vessel, usually the artery, ruptures between the surface of the dura mater and the skull. Morbidity and mortality from epidural hematoma is substantial unless immediate medical attention is given. The cause of epidural hematoma is most of the time road automobile accidents or any other traumatic injuries.


Intraparenchymal hematoma: When blood pools in the white matter of the brain, Intraparenchymal hematoma occurs. There may be multiple severe Intraparenchymal hematomas after a head trauma. Serious brain damage can occur, as the neurons can no longer communicate.

A physician may find it difficult to diagnose intracranial hematoma, as it may not be immediately apparent. It is better to seek medical advice after any significant blow has been received to the head and if the patient has lost consciousness or experiences symptoms such as headache, lethargy, nausea and vomiting. A CT scan or MRI scan is suggested to define the position and size of a hematoma.


After a head injury, doctors use medications such as corticosteroids and diuretics to control the edema in the brain after head injury. Often surgery is required. If the blood clot is localized and there is no excessive clotting, then perforation is made through the skull and the liquid is removed by suction. Large hematomas require opening of a section of the skull to remove blood clots.

It is essential to wear appropriate safety equipment and gadgets during sports, including helmet when riding, motorcycling, horseback riding, skating or doing any other activity that may result in injury to head. Chances of motor vehicle accidents can be minimized by wearing a seat belt.

Optic Disk Swelling

A doctor checks into the eye with an ophthalmoscope when there are regular complaints of headache, nausea or vomiting. This is to check for the appearance of the optic nerve and the blood vessels that pass through the eye. Swelling of the optic nerve is called Papilledema.


The optic nerve is a thick cord that connects the back of each eyeball and its retina to the brain. The cerebral spinal fluid protects the nerve between the brain and eye. Even if there is a slight increase in the pressure of this fluid, due to swelling in the brain, the optic nerve can get compressed around its whole circumference in a choking manner. The optic nerve can bulge whenever it develops inflammation on its own - causing Papilledema.

Such swelling of the optic nerve head can also be caused due to intracranial pressure. This could be due to an underlying brain tumor or brain infection such as abscess, meningitis or encephalitis. In fact many who are diagnosed with brain tumors exhibit Papilledema. Sometimes this can be caused due to high blood pressure.


Causes of Papilledema :

  • Tumor of the Brain, Skull, Spinal column or cord, optic nerve
  • Hydrocephalus - accumulation of cerebrospinal fluid within the skull
  • Intracranial infections such as encephalitis, meningitis
  • Abscess - Accumulation of Pus, Hemorrhage or trauma to the head
  • Craniosynostosis - Abnormal closure of the skull bones

Symptoms of Papilledema :

  • Headaches - especially the types which become severe on awakening; headaches that become exacerbated by coughing or holding breath
  • Nausea and Vomiting
  • Changes in vision manifesting in the form of double vision, flickering, transient blurring or graying

Pseudo tumor cerebri or benign intracranial hypertension is one condition which can cause increased pressure in the cerebral spinal fluid. This is caused when the body makes too much spinal fluid. This is common in women especially who are obese and of child bearing age, and at such times when the body is adjusting to hormone changes such as pregnancy, the first menstrual period or menopause. It is better to go in immediately for neuro-imaging and MRI to check the cerebral cenous sinuses. A lumbar puncture could be done to check the opening pressure as well as CSF (cerebro spinal fluid) test, Fluorescein Angiography - an eye test specifically intended to check the blood flow in the Retina and Choroid, if there is diagnostic uncertainty. In some cases ultrasonography and Retinal Tomography may be used to get 3D data and image.


Although a swollen optic nerve tends to improve over a period of time, it may take months for complete restoration of normal vision. Doctors usually treat with intravenous steroid drugs but this process may have little effect on vision in some cases, although it may help to improve overall health.


Encephalitis

Encephalitis in an acute inflammation of the brain. Caused by herpes simplex virus, encephalitis causes cerebral edema thereby destroying nerve cells. This may lead to bleeding in the brain and brain damage. Encephalitis is often caused by the virus that causes mumps, measles, rabies, polio and rubella. Symptoms of encephalitis may begin with a stomach infection, headache and fever. It can also manifest in vomiting, drowsiness and clumsy gait. Severe headache and muscle or loss of consciousness are severe symptoms.


Brain MRI and CT scan of the head might be necessary to diagnose encephalitis. Serology tests and lumbar puncture and CSF examination might be done. Examination of the patient might show increased intracranial pressure, abnormal reflexes and mental confusion. The patient is given nutrition through fluids and anti-viral medicines such as acyclovir and foscarnet. Anti-seizures might be given. Antibiotics are prescribed in case the infection is caused by bacteria.

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Collection of Pages - Last revised Date: September 23, 2019