What is Intracranial Hemorrhage?

An intracranial hemorrhage is bleeding inside the skull (cranium). This can occur suddenly when blood vessel is torn or leaks. The leaking blood (hemorrhage) forms a mass that puts pressure on the brain, causes swelling and interrupts the flow of oxygen to the brain. The lack of oxygen kills brain cells and can affect nerve cells that help control movement, speech and memory. 

Baptist Health is known for advanced, superior care in diagnosing and treating intracranial hemorrhage. Our 24/7 inpatient neurology and neurosurgery services, as well as our outpatient and Home Health physical, occupational, cognitive and speech therapy services are available to help treat people with intracranial hemorrhage. In addition, we have the region’s only advanced 3Tesla MRI, MRI spectroscopy and functional MRI, MRI angiography, CT angiography and conventional cerebral angiography technology to accurately diagnose all manner of neurologic disease, including intracranial hemorrhage.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Intracranial hemorrhage signs and symptoms can develop over time or occur suddenly. They may differ, based on the size, location and severity of the bleeding. Symptoms include:

• Blurred or double vision
• Confusion
• Loss of balance
• Loss of consciousness
• Nausea or vomiting
• Seizures
• Slurred speech
• Sluggishness or stupor
• Sudden, very severe headache
• Weakness, numbness, tingling or paralysis in the arm or leg or on one side of the face
• Trouble speaking, swallowing, writing or reading

If any of these symptoms occur, call 9-1-1 immediately for emergency treatment.

Diagnosis

A physician will evaluate physical symptoms to diagnose if someone has an intracranial hemorrhage. We also use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Cerebral angiogram: A thin tube (catheter) can be inserted into a blood vessel in the groin and dye injected to make the blood vessels in the brain visible during a series of X-rays. These images can reveal details about the conditions of the arteries and show where bleeding is occurring.

Blood Test: Blood tests check levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions that could cause an aneurysm – a weakening of blood vessel walls – to develop.

Cerebrospinal fluid test: The physician may order a test to examine cerebrospinal fluid if symptoms of a ruptured aneurysm are present, but a CT scan hasn’t shown evidence of bleeding. The procedure, which draws fluid from the spine with a needle, is called a lumbar puncture or spinal tap.

Computerized tomography (CT) scan: This test uses X-rays and computers to create images of the brain. Sometimes, a patient will be injected with contrast dye to see if there is bleeding inside the skull.

Magnetic resonance imaging (MRI): This test uses a powerful magnet and radio waves to produce images of the brain. A type of MRI that assesses the arteries in detail (MRI angiography) may detect the cause of the bleeding.

Doppler vascular studies: A transducer (microphone) placed on the skin sends ultrasonic sound waves that echo off of blood cells and can be heard through an amplifier. Listening to beats of blood flow can help determine if a blockage is caused by a blood clot, fatty buildup in blood vessels or inflammation.

Causes

Causes of intracranial hemorrhage can be inherited or related to a disease or defect, but some lifestyle factors do increase the risk of developing one. The causes include:

• Alcohol abuse
• Blockage, rupture or leaking of an artery in the brain
• Blood thinners
• Drug abuse, especially cocaine use
• Head trauma
• High blood pressure
• Pregnancy or childbirth conditions
• Smoking 

Risk Factors

Risk factors that may contribute to intracranial hemorrhage include:

Age: Most aneurysms develop in adults over the age of 40.

Amyloid angiopathy: Blood vessel walls can be affected by aging and high blood pressure. Small amounts of bleeding in the brain may go unnoticed before a larger bleeding event occurs.

Bleeding disorders: Sickle cell anemia and hemophilia can decrease blood platelets that help blood clot to stop bleeding.

Blood clot: A blood clot can block a blood vessel, cause it to burst and lead to bleeding in the skull.

Brain tumor: Pressure from a growing tumor can cause bleeding inside the skull.

Arteriovenous malformation: This birth defect can cause weakness of blood vessels around the brain and may not be noticed until symptoms occur. 

Family history of brain aneurysm: This risk sometimes runs in families, and a person may be more suffer a hemorrhage if a first-degree relative, such as a parent, brother or sister has had a brain aneurysm.

Head injury: A head injury can cause an aneurysm to form or rupture. Injury to the head is the most common factor in people under 50 years old who suffer an intracranial hemorrhage.

Liver disease: This condition can increase bleeding in general.

Medications: Common blood-thinning medications such as aspirin, Plavix, Coumadin and Pradaxa all carry an increased risk of bleeding complications.

Prevention

There is no known way to prevent all types of intracranial hemorrhage, but you can lower your risk doing the following things:

Get regular check-ups: This is especially important if you are taking a blood thinner or have abnormalities that have led to previous aneurysms.
Practice good health: Quit smoking, do not use illegal drugs and reduce alcohol consumption.
Protect your head: Wear a helmet when riding a motorcycle or bicycle and a seat belt when riding in a car.
Take medicines as prescribed: If you have high blood pressure or high cholesterol, take your prescribed medications as directed.

Prognosis

The prognosis is good for a person who had an intracranial hemorrhage and regains consciousness, completes therapies to recover and is in good health. A person who remains in a coma or paralyzed after an intracranial hemorrhage may require long-term nursing home care.

Treatment and Recovery

Emergency treatment is needed to treat an intracranial hemorrhage. Immediate medical help can stop bleeding and reduce damage to brain cells and nerves that control body movements. Treatments for an intracranial hemorrhage can include:

Medication

Common medications prescribed to reduce symptoms and manage complications include:

• Anti-anxiety medication to control blood pressure
• Anti-seizure medication to control seizures
• Calcium channel blockers, which prevent narrowing spasms of blood vessel walls
• Nutrients and fluids given through a vein or stomach feeding tube if swallowing is difficult
• Pain relievers for headache
• Medication for constipation to prevent straining during bowel movements
• Medications to rapidly control blood pressure
• Medications to reverse the effect of blood thinners

Rehabilitative Therapy

A person may need physical, speech and/or occupational therapy to relearn skills and develop a healthy lifestyle.

Surgical Procedures

Procedures to control an intracranial hemorrhage include:

Decompression: A surgeon creates an opening in the skull to release pooled blood that is pressuring the brain. Damaged blood vessels will be repaired during this procedure.

Surgical clipping: A surgeon removes a section of the skull to access the aneurysm and places a small metal clip on the neck of the aneurysm to stop blood flow.

Endovascular procedure: A surgeon may insert a small tube into the large blood vessel of your groin to stop and control bleeding from inside the damaged blood vessel.

Complications

Complications of an intracranial hemorrhage can vary and some can be long-lasting, based on the extent and location of the damage, including:

• Change in personality or emotions
• Confusion and poor judgment
• Difficulty swallowing
• Inability to understand words
• Loss of speech, memory and movement in affected areas of the body
• Numbness or weakness
• Sleep problems
• Stroke
• Vision loss