Definition

A hematoma is an abnormal collection of blood outside of blood vessels. This occurs when blood vessels are damaged, leading to blood leaking into the surrounding tissue (hemorrhage). In an intracerebral hematoma, this blood collection occurs inside the brain due to damaged blood vessels within the brain. Intracerebral hematomas can increase pressure inside the skull, compressing other brain tissues. Brain hemorrhages are critical conditions that require immediate medical treatment. Early intervention can reduce the likelihood of permanent brain damage, disability, and death.

Causes

Intracerebral hematomas can be caused by high blood pressure, which leads to the rupture of brain blood vessels (hemorrhagic stroke). Other causes include head injuries from accidents or falls. Traffic accidents falls from heights, and sports-related head injuries are common causes of brain hemorrhages. 

Brain aneurysms (weak spots in brain blood vessels that rupture), vascular malformations (abnormal blood vessels in the brain disrupting normal blood flow), blood thinners (commonly used for heart disease), tumors, illicit drug use (such as cocaine or methamphetamine causing severe hypertension), and bleeding disorders like hemophilia can also cause intracerebral hematomas. Decreased platelet count can lead to brain hemorrhage, as can sickle cell anemia (abnormally shaped red blood cells causing bleeding) and amyloid angiopathy (blood vessel wall abnormalities due to age or hypertension), which can cause multiple small hemorrhages leading to a larger bleed.

Risk factor

An intracerebral hematoma is more common in men than women, especially those over 55 years old. Excessive alcohol consumption, anticoagulant or blood-thinning medications like warfarin, illicit drug use, unhealthy diets, uncontrolled blood pressure, conditions like chronic kidney failure and eclampsia, excessive sleep or sleep disorders, genetic conditions that weaken blood vessels, and low education levels linked to a lack of primary prevention awareness and healthcare access all increase the risk of intracerebral hematoma.

Symptoms

Clinical symptoms of intracerebral hematoma arise from blood clots in the brain. Spontaneous intracerebral hematomas usually occur during activity and rarely during sleep. Symptoms include:

• General loss of consciousness, varying in frequency and degree depending on the location and size of the hemorrhage.
• Severe headache and vomiting, indicating increased pressure in the brain.
• Partial limb weakness.
• Tingling sensations.
• Facial, arm, or leg paralysis, especially on one side of the body.
• Seizures.
• Difficulty swallowing.
• Vision problems in one or both eyes.
• Loss of balance and coordination.
• Difficulty with language skills (reading, writing, speaking, and understanding).
• Apathy.
• Drowsiness.
• Lethargy.
• Confusion (delirium).

Diagnosis

Diagnosis of intracerebral hematoma involves detailed interviews (anamnesis) regarding when the symptoms began, triggers, any existing health conditions, and symptoms experienced before seeing a doctor. Physical examinations include checking consciousness, vision, neurological assessments for facial or limb weakness (arms and legs), swallowing, and speech difficulties.

Imaging tests are essential to determine if the patient has an intracerebral hematoma (bleeding) or ischemic stroke (blockage). Diagnostic tests for intracerebral hemorrhage include CT scans and MRI scans. These tests help doctors see clear images of the brain to identify the cause of the bleeding. An angiogram, a technique using X-ray technology to capture blood flow in arteries, can detect abnormalities like aneurysms or arteriovenous malformations. Blood tests can identify if the patient's symptoms are due to brain infections, blood clotting problems, or immune system issues.

Management

An intracerebral hematoma is a serious condition requiring immediate treatment. Treatment within the first 3 hours of symptom onset has a high survival rate. Initial management may include pain relief and medications to reduce brain pressure. For brain hemorrhage caused by high blood pressure, intravenous antihypertensive medications may be given. Anticonvulsant medications are used to prevent seizures, as most seizures occur within one week of brain hemorrhage.

Severe intracerebral hematomas with extensive bleeding may require surgery to reduce brain pressure and repair damaged blood vessels. Surgical options include neurosurgical clipping (clipping a ruptured aneurysm to prevent recurrent bleeding) or endovascular coiling (blocking blood flow to the aneurysm area to stop bleeding).

Complications

Patients with intracerebral hematoma can experience serious complications within days or weeks after the hemorrhage. These include hydrocephalus (fluid buildup in the brain increasing head pressure or damaging brain tissue), blood vessel narrowing reducing oxygen-carrying blood flow to the brain, recurrent brain hemorrhage, and seizures. Other complications from symptoms like limb weakness or paralysis can lead to deep vein thrombosis from prolonged immobility, aspiration pneumonia from choking on food, and depression.

Prevention

Preventing intracerebral hematoma involves reducing bleeding risks such as not smoking, treating existing heart disease, regular check-ups with a cardiologist, taking medications for other conditions as prescribed, maintaining normal blood pressure, controlling blood sugar, and leading a healthy lifestyle. For patients with a history of brain hemorrhage, avoiding straining or severe coughing is advised to prevent worsening bleeding.

When to see a doctor?

Intracerebral hematoma cases can develop rapidly, and within hours or minutes, brain cell damage from bleeding can become permanent, necessitating quick intervention. Patients should seek immediate medical attention if experiencing loss of consciousness, vomiting without nausea, head injury, seizures, partial limb weakness, tingling, vision problems, slurred speech, and confusion (delirium).

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