Intracranial Hematoma Definition:

• a collection of blood inside the skull, usually from a burst blood vessel or head injury, that can be dangerous as the hematoma presses on the brain and also induces inflammation which can further increase intracranial pressure (ICP).

1.  Epidural Hematoma

• Location: Between skull and dura mater (extra dural space, epidural).
• Often caused by arterial bleed, more accessible surgically.
• Symptoms: Loss of consciousness, then a lucid interval, followed by rapid deterioration.
• • Requires monitoring and possibly surgical removal.

2.  Subdural Hematoma

• Location: Between dura mater and arachnoid mater (subdural space).
• Usually venous bleed, slower onset.
• Symptoms: Headache, confusion, progressing to coma.
• • Requires monitoring and possibly surgical removal.

3.  Subarachnoid Hemorrhage

• Bleeding into the subarachnoid space between arachnoid and pia mater.
  • Drains via arachnoid villi into venous system.
  • Usually does not increase ICP significantly.
• Blood mixes with CSF in the subarachnoid space, and can drain through dura (venous) sinuses into jugular vein, leading to less chance of increased ICP, in comparison with with intracranial hematomas – unless dura sinus(es) are obstructed.
• Symptoms: Sudden headache, neck stiffness, nausea.

4.  Intracerebral Hematoma

• Bleeding within brain tissue itself.
• Often occurs after shearing injury or rupture of vessels.
• Develops over days; symptomatic from mass effect and bleeding.
• • Requires monitoring and possibly surgical removal.

Pathophysiology and Effects of Hematomas

• Hematomas increase volume within the skull.
• Expanding mass causes pressure:
  • Compresses surrounding tissue.
  • Elevated intracranial pressure (ICP).
• Collapse of vessels causes ischemia.
• Blood cell rupture releases hemoglobin and electrolytes:
  • Draws water into the space (edema).
  • May worsen ICP further.
• Neuronal death occurs if ICP is not relieved.

Intra-cranial Pressure & Compensation

• CSF circulates in ventricles, produced in the choroid plexus.
• Increased ICP causes ventricles to shrink as CSF is pushed out.
• Excess blood or swelling can push on brain tissue.

Intracranial Hematomas:  Critical Considerations

• Continuous imaging (CT, MRI) essential for monitoring.
• Rapid decompression or hematoma evacuation to prevent brain herniation.
  • • Craniectomy:
      • Removal of part of the skull to relieve pressure.
    • Hematoma evacuation:
      • Remove subdural or epidural hematomas.
      • Typically performed if the hematoma is large or causing significant pressure.
• Careful management to reduce ICP, prevent brain ischemia.
• Supportive Care
  • Blood transfusions if hemorrhage is severe.
  • Monitoring ICP:
    • Use catheters and pressure monitors.
  • Prevent secondary damage:
    • Maintain blood pressure, oxygenation, and nutritional support.

Summary

• Skull fractures and intracranial hematomas can cause life-threatening pressure.
• Imaging is essential for accurate diagnosis and management.
• Pharmacologic and surgical treatments aim to reduce ICP, prevent neuronal death, and treat underlying blood/fluid collections.
• Hematoma types depend on location (epidural, subdural, subarachnoid, intracerebral).
• Early detection and treatment are vital to prevent brain herniation and death.