Brain Hematoma is a medical emergency that requires prompt diagnosis to help prevent the risk of disabilities and death.  

Individuals with a brain hematoma (bleed or blot clot) may not initially display any symptoms until the hematoma develops over time. Select hematomas are absorbed by the body and do not require treatment.  Depending upon the speed or change in speed of the bleed, the condition of the individual may swiftly deteriorate, posing a risk of disabilities and eminent death. Symptoms may include one or more of the following and/or other serious neurological symptoms.

• Fluctuating level of consciousness or loss of consciousness
  
• Personality changes
• Numbness
• Disorientation or amnesia
• Dizziness
• Weakness
• Loss of appetite
• Difficulty seeing, hearing and/or breathing
  

The Pathway of a Cerebral Hematoma

Subdural Hematoma is usually signified by a bleed in the brain that lies between the dura mater closest to the skull and the arachnoid mater that surrounds the brain following tears across veins in the brain. The consequence causes blood clotting which leads to intracranial pressure (ICP) that may be damaging to the brain. The elderly and infants (skaken baby syndrome) are at a greater risk of a subdural hematoma due to the tendency in infants to have larger subdural spaces and in the elderly to have  fragile veins.  Even what may seem to be a slight blow or shake of the head without an open wound may be enough to bring about a subdural hematoma over time. Hematomas may also be the consequence of long term alcohol abuse or long term use of anticoagulants. There are three types of Subdural Hematomas, depending upon the speed of growth,  including: Acute, Subacute and Chronic.

Conversely, epidural hematomas are usually caused by tears in arteries, resulting in a collection of blood between the dura mater and skull that raises intracranial pressure. In turn, the brain may lose its blood supply. Epidural bleeds may not seem problematic initially but may quickly compress areas inside the brain and brain stem, resulting in abnormal eye pupil responses to light and unconsciousness when not treated in a swift time frame. A epidural hematoma may be the consequence of a shift in the brain caused atypical movement, known as a contrecoup injury.

Diagnostic Testing for Brain Hematomas

Following a blow or a shake to the head, individuals should undergo a complete evaluation, thorough neurological exam and diagnostic testing at an emergency room. Even minor head injuries are cause for observation, particularly for infants, youths and seniors.

A CT Scan or MRI may be ordered to detect a brain hematoma on an emergency basis. However, small hematomas may not be detectable on CT or MRI Scans and may grow over time to become unmanageable without timely surgical intervention.   

In select cases, small hematomas that do not produce symptoms may be monitored to identify the body’s ability to heal itself or the rate of growth. In other cases, small hematomas may be “vacuumed out” through a tiny catheter that is inserted through a small hole (burr hole) drilled in the skull with the aid of a trephine instrument.  

Individuals who are experiencing symptoms and those who have large hematomas may qualify for a procedure known as craniotomy. During this procedure, the skull and dura portion of the brain are opened surgically. Then, a “vacuum” suction technique or irrigation technique is used to identify bleed sites, control bleeding, remove the blood clot and repair injured blood vessels.     

Outcome of Brain Hematoma

In certain cases, the body may heal itself and absorb the collection of blood to leave no ill effects. The quality in the outcome of surgical approach depends upon numerous factors, including,  but not limited to:

• the individual’s condition prior to treatment
• the size of the hematoma
• the extent of deterioration in the brain
• the age of the individual
• the risk of complications and the outcome of management  for a complication should one arise.

Select individuals may benefit from rehabilitation following surgery. This may include: physical, occupational and speech or cognitive therapies.

The prognosis in Chronic subdural hematoma is better when compared to a higher mortality rate associated with Acute and Subacute Subdural Hematomas. Early invention plays a role in the outcome of bleeds that grow quickly. Study results suggest that the overall mortality rate for Epidural Hematomas is lower when compared to Subdural Hematomas. The results from treatment are generally better for individuals who arrive at the emergency room lucid when compared to those who arrive impaired or unconscious.

It is important to recognize that medications and medical procedures are associated with benefits and risks that should be discussed with your physician. It is important to recognize that all information contained on this website cannot be considered to be specific medical diagnosis, medical treatment, or medical advice. As always, you should consult with a physician regarding any medical condition. Your Health Access disclaims any liability for the decisions you make based on this information.