Bleeding, Intracranial

WHAT YOU SHOULD KNOW

Any type of hemorrhage inside the skull is known medically as intracranial bleeding. The problem is categorized according to its exact location:

• Intracerebral hemorrhage: bleeding inside the brain
• Subarachnoid hemorrhage: bleeding in the space between the innermost membrane covering the brain (the pia mater) and the layer immediately above it (the arachnoid membrane)
• Subdural hemorrhage: bleeding between the arachnoid membrane and the outer layer of the brain's protective covering (the dura mater)
• Epidural or extradural hemorrhage: bleeding between the skull and the dura mater.

Any type of intracranial bleeding can become life-threatening if not treated immediately.

Causes

Head injuries sustained during accidents are the most common cause of intracranial bleeding. Strokes can also cause this problem. Occasionally the culprit is an arteriovenous malformation, a tangle of swollen arteries and veins in or near the brain. Dangerous bleeding can also result if an aneurysm (a swollen segment of an artery) weakens and bursts.

Signs/Symptoms

In severe cases, the victim immediately loses consciousness. In milder cases, the most common signs are persistent headache, fluctuating drowsiness, confusion, nausea, vomiting, memory changes, difficulty speaking, and minor paralysis on one side of the body. Left untreated, the victim will eventually become unconscious.

Care

If you suspect intracranial bleeding, seek medical care immediately. The problem usually surfaces quite suddenly, and there is nothing you can do to effectively manage it on your own. To drain the build-up of blood and relieve the pressure it puts on the brain, a craniotomy (opening of the skull) may be needed.

Risks

Intracranial bleeding is one of the leading causes of death in people under the age of 50. Even with prompt medical attention, long-term brain damage---and even death---remain possibilities.

WHAT YOU SHOULD DO

Any head injury, no matter how slight, should be evaluated by a physician immediately, particularly if the victim is an infant or an older adult.

Seek Care Immediately If...

You experience any of the following:

• Headache (either steady or intermittent)
• Confusion
• Seizures
• Difficulty breathing, speaking, or swallowing
• One pupil becomes much larger than the other
• Vision changes
• Eye pain

Call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself.

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may encounter the following procedures and equipment during your stay.

• Taking Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• Oxygen: Your body may need extra oxygen. It will be given by either a mask or nasal prongs.
• Pulse Oximeter: This is a clip placed on your ear, finger, or toe and connected to a machine that measures the oxygen in your blood.
• Neuro Signs: The doctor will examine your eyes, test your memory, and check how easily you awaken. These tests give the doctor vital information on how well your brain is handling the injury.
• IV: A tube placed in your vein for giving medications or liquids. It will either be capped or have tubing connected to it.
• Blood: Samples will be taken from a vein in your hand or the bend in your elbow to be used for testing.
• CT Scan: Computerized axial tomography, also known as a CAT scan, provides the doctor with images of the inside of the brain.
• MRI: Magnetic resonance imaging also yields diagnostic pictures of the brain.
• ECG: Also known as a heart monitor, an electrocardiograph or an EKG. Patches placed on your chest are hooked up to a TV-like monitor which shows a tracing of each heartbeat. Doctors use this tool to watch for signs of heart trouble that could be related to your head trauma.
• EEG: This is a brain wave study that allows doctors to detect brain damage that other tests may fail to reveal. Also known as an electroencephalogram.
• Surgery: If a craniotomy is necessary, it will be performed under general anesthesia. The hair will be shaved away at the point where the opening will be made, and a small section of the skull will be removed through an incision in the scalp. Once the accumulated blood has been drained, the bone will be replaced and the scalp will be stitched closed.

After You Leave

• Rest in bed, stay warm, and limit your normal activities as much as possible for a few days.
• Drink plenty of liquids everyday. Certain medications used to treat head injuries make you more susceptible to dehydration.
• DO NOT take any medications without first checking with your doctor.
• Plan to have someone with you at home for at least the first 24 hours to wake you every few hours, make sure that your symptoms don't return, and watch for any other complications.
• If you have undergone surgery to drain the hematoma, your recovery will take longer. Follow your doctor's wound-care instructions precisely to ensure that the scalp incision heals properly. Keep the area dry and change the dressing regularly.
• Depending upon its severity, you may be unable to remember the circumstances surrounding your head injury. You may also continue to experience, at times, seizures, attention difficulties, anxiety, and headaches. These symptoms sometimes persist for as long as six months after treatment. Some people continue to suffer some neurologic disorders indefinitely.