Intracranial Hemorrhage

by Sam Malone

Intracranial hemorrhage is the term used to describe bleeding within the skull or cranium. There are two types of intracranial hemorrhaging. Bleeding that occurs within the brain is known as cerebral or intracerebral hemorrhage. Bleeding that results from a ruptured or leaking blood vessel is known as a hemorrhagic stroke.

Intracranial hemorrhages usually develop suddenly, either caused by external or internal factors. The hemorrhage can result in rapid brain and nerve damage and can be life threatening if not treated.

The brain, like any other organ, requires oxygen for its survival and cannot store it. Oxygen is supplied to the brain by a series of blood vessels. The blood vessels also supply the brain with the nutrients required for its normal functioning. Any kind of intracranial hemorrhage will cause blood to pool and exert pressure on the brain. Along with oxygen deprivation, the pooling of blood will exert a pressure against the brain and may lead to further damage. This will affect the functioning of that particular part of the brain. The symptoms and treatment for an intracranial hemorrhage will depend on the location and extent of the bleeding as well as the underlying cause.

Brain cells and nerves that are deprived of oxygen for more than 3 to 4 minutes will begin to die of oxygen starvation. This will affect the functions that are associated by that particular part of the brain. Cerebral hemorrhages can be classified as:

  • Intracerebral Hemorrhages: This is bleeding within the brain. The symptoms of these hemorrhages and prognosis will depend on the size and location of the bleeding.
  • Subarachnoid Hemorrhages: This is bleeding between the brain and the membranes that encapsulate and protect it.
  • Subdural Hemorrhages: This is bleeding that occurs in between the meninges or layers that cover the brain.
  • Epidural Hemorrhages: This is bleeding between the skull and the outermost membrane covering the brain.

Some of the common causes of intracranial hemorrhages include:

  • Head Injuries: This is the most common cause of intracranial hemorrhages in the case of those under the age of 50. Its incidence decreases amongst the elderly.
  • Arteriovenous Malformation (AVM): Any abnormality in the arteries or veins in or around the brain can cause a hemorrhage to occur. This kind of defect may be present at birth and is usually only detected when symptoms develop. The symptoms will vary depending on the size and the location.
  • Aneurysm: This is a weakening in the walls of a blood vessel that causes it to swell. The swelling occurs because of the pressure exerted by blood against the weakened wall of the blood vessel. The weakened walls of the aneurysm may burst and lead to a hemorrhagic stroke.
  • Hypertension: A common cause of cerebral stroke, hypertension can over the long term, lead to a weakening of the blood vessel walls and result in intracranial hemorrhaging.

The symptoms of intracranial hemorrhage can vary depending on the extent and location of the bleeding. They include:

  • A sudden headache
  • Increasing loss of neurologic functioning such as weakness, partial paralysis, numbness, loss of speech, loss of vision and confusion
  • Nausea and vomiting
  • Seizures
  • Loss of consciousness

CT scans, MRI scans and other imaging tests may be required to confirm a diagnosis of intracranial bleeding. The scans will also help determine the site and extent of the bleeding.

Treatment for intracranial hemorrhage will depend on a variety of factors including the location of the bleeding, its underlying cause and the size of the clot or rupture. A multi-disciplinary team of doctors may be involved in the treatment. Interventional radiology may be used to widen or close off blood vessels without surgery or to correct blood vessel abnormalities. Surgery may also be required.

The prognosis will depend upon the degree of paralysis, with those who are in a coma or severely paralyzed requiring long term nursing home care. In extreme cases, death may occur. For those who remain conscious, rehabilitative therapy can lead to substantial recovery.    



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