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 intracranial 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.

Brain MRI

MRI technique is used to examine the brain as it helps to provide clear pictures of the parts of body that are surrounded by bone tissue. Detailed pictures of both benign and malignant abnormal growth of tumors in the brain can be obtained through brain MRI scan. The MRI scan is also indicative whether the tumor is spread to the nearly brain tissue or not. MRI scan can detect the abnormal tissues that grow during multiple sclerosis and the changes occurring during bleeding in the brain or if the brain tissue has suffered a stroke due to lack of oxygen. The functional magnetic resonance imaging is a relatively new procedure. This is used to measure the quick, tiny, metabolic changes that take place in an active part of the brain. The functional magnetic resonance imaging not only helps the radiologist to examine the anatomy of the brain but also to determine the precise part of the brain which is handling the critical aspects of speech, movement and sensation.

Epilepsy

Epileptic seizures are commonly traced to brain injury or family history. About 0.5% to 2% of the population is likely to suffer an epileptic seizure at some point in time. When the delicate balance of electrical activity in the brain is disturbed, a person suffers seizures. When there are more than a couple of episodes of seizures, it is a condition of epilepsy. In a typical epileptic seizure, the neuronal activity is hampered bringing on convulsions, muscle spasms and possible loss of consciousness. Each person has a different threshold of resistance to seizures. Inherited condition of neurological disorder can lead to electrical instability causing epileptic seizures. Those dependent on alcohol or drugs may experience seizures during withdrawal. Rarely is a brain tumor the cause of epilepsy. Brain injury is a possible cause of epilepsy. This can be due to a birth defect or head injury or infection such as meningitis. Sometimes a person may experience idiopathic epilepsy where there is no clear cause for the seizures.

Diagnosis of epilepsy can be made with investigative tests such as EEG, CT scan or MRI scan. Anti-epilepsy drugs (AEDs) can control the seizures though there is no cure. These medications help the patient in leading a better quality of life. AEDs are prescribed after studying the person's nature of seizures, general health, age and gender. These medications must be taken in prescribed doses to maintain desired level in the body to prevent further seizures. When some possible triggers have been identified for epileptic seizures, the patient must try and avoid them. These triggers could range from emotional disturbance to lack of sleep. The vagus nerve stimulator(VNS) has been approved by the FDA for the treatment of epilepsy. The VNS is surgically implanted into the chest, near the collarbone. It is a small device, much like a pacemaker that sends weak electrical impulses to the brain through the vagus nerve. These electrical signals are helpful in preventing sudden electrical bursts in the brain that trigger off an epileptic attack.