Intracerebral Hematomas in Car Accidents

An intracerebral hematoma is also called an intracranial hemorrhage, a hypertensive hemorrhage or hemorrhagic cerebrovascular disease. It can be caused by a stroke or from a traumatic event that causes bleeding within the brain due to broken blood vessels. The bleeding may occur within the brain tissues or in the spaces between the brain and its covering membranes. Bleeding can occur in all parts of the brain or only in one hemisphere or in the deeper structures of the brain.

Other causes of an intracerebral hemorrhage include an aneurysm of a blood vessel, high blood pressure bursting a blood vessel, protein deposits along the blood vessels, and a traumatic brain injury (often referred to as TBI). Blood is irritating to the brain tissue so that it swells. A mass of blood can form, known as a hematoma. Either of these things can increase the pressure on adjacent brain tissue so that it destroys that tissue, too.

Risk factors for an intracerebral hematoma include bleeding disorders, disseminated intravascular coagulation, hemophilia, decreased platelet count, sickle cell anemia or leukemia. Certain brain tumors can increase the risk of a bleed as can liver disorders, aspirin use and prematurity.

Symptoms vary due to the location of the bleeding and the size of the bleed. The symptoms occur without warning and usually happen during activity. They include, loss of consciousness, taste abnormalities, being apathetic or sleepy, having difficulty sleeping, having difficulty understanding speech, having difficulty writing or reading, problems swallowing, headache, lack of coordination, balance difficulties, difficulty moving a body part, tremors, loss of fine motor skills, weakness of a body part, seizures, nausea, vomiting, abnormal sensation, and visual changes like double vision, loss of vision or change in pupil size.

Doctors can do a physical examination including a neurological examination to find evidence of increased intracranial pressure. The doctor looks for abnormal reflexes, decreased vision, changes in eye movement, inability to sense things normally or loss of movement and coordination. The doctor also looks at the optic nerve for signs of swelling.

Tests can be done to show evidence of intracranial swelling including checking the bleeding time, CT angiography, blood count, head CT scan, MRI of the brain, liver tests, kidney tests, platelet count and other tests of bleeding.

Treatment of an intracerebral bleed is a difficult problem to treat. It can quickly become life threatening if not treated promptly. Treatment depends on the amount of hemorrhage and its location. Surgery may need to be done to stop the bleeding and drain the blood out of the brain. If there is a cerebral aneurysm, this may need to be surgically removed.

Medications used to treat the problem include medications for seizures, corticosteroids to decrease swelling, diuretics to reduce swelling and medications for pain. Blood or blood products may need to be added in order to replace blood that is lost from the circulation.
The prognosis depends on the location and size of the bleed as well as the amount of swelling the patient has.

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