Intracranial Bleeding (ICB)
Intracranial hemorrhage (ICH) : Overview, Types, and Management
Definition
Intracranial hemorrhage (ICH) refers to bleeding within the skull, which may occur in the brain parenchyma, surrounding meningeal layers, or ventricles. It is a medical emergency requiring immediate intervention to prevent permanent brain damage or death178.
Types of Intracranial Bleeding
ICH is classified into four main types based on location:
| Type | Location | Key Causes | CT Scan Appearance |
|---|---|---|---|
| Epidural Hematoma | Between skull and dura mater | Trauma with skull fracture (e.g., middle meningeal artery rupture) | Biconvex (“lens-shaped”) hyperdensity |
| Subdural Hematoma | Between dura and arachnoid mater | Head trauma (common in elderly, alcoholics), shaken baby syndrome | Crescent-shaped hyperdensity |
| Subarachnoid Hemorrhage | Between arachnoid and pia mater | Ruptured cerebral aneurysm, trauma | Hyperdensity in basal cisterns |
| Intracerebral Hemorrhage | Within brain parenchyma or ventricles | Hypertension, cerebral amyloid angiopathy, vascular malformations, tumors | Hyperdense mass in brain tissue |
Causes and Risk Factors
- Trauma: Falls, vehicular accidents, physical assault8.
- Hypertension: Most common cause of spontaneous intracerebral hemorrhage38.
- Vascular Abnormalities: Aneurysms, arteriovenous malformations (AVMs), cerebral amyloid angiopathy38.
- Bleeding Disorders: Hemophilia, thrombocytopenia, anticoagulant use (warfarin, DOACs)38.
- Other: Brain tumors, eclampsia, illicit drug use (cocaine), infections38.
Risk Factors: Age >55, smoking, alcohol abuse, chronic kidney disease, obesity38.
Symptoms
- Sudden severe headache (e.g., “thunderclap” headache in subarachnoid hemorrhage)34.
- Neurological deficits: Weakness/paralysis on one side, slurred speech, vision changes34.
- Altered consciousness: Confusion, lethargy, coma38.
- Nausea/vomiting, neck stiffness, seizures34.
- Autonomic dysfunction: Irregular breathing, abnormal heart rate (brainstem involvement)3.
Diagnosis
- Non-contrast CT scan: First-line imaging to detect hemorrhage location, volume, and mass effect59.
- MRI/MRA: For evaluating underlying causes (e.g., tumors, vascular malformations)46.
- Angiography: To identify aneurysms or AVMs46.
- Lumbar puncture: If subarachnoid hemorrhage is suspected but CT is negative4.
Treatment
Emergency Management
- Blood pressure control: Target systolic BP <140 mmHg (for intracerebral hemorrhage)35.
- Anticonvulsants: For seizure prevention3.
- Reversal of anticoagulants: Vitamin K, prothrombin complex concentrate (PCC)35.
Surgical Interventions
- Craniotomy: Evacuation of large hematomas causing mass effect36.
- Endovascular embolization: For aneurysms or AVMs using catheter-guided techniques6.
- Ventriculostomy: To relieve hydrocephalus5.
Non-Surgical Options
- Conservative management: For small bleeds without neurological decline3.
- Rehabilitation: Physical, occupational, and speech therapy post-recovery36.
Complications
- Increased intracranial pressure (ICP): Risk of brain herniation8.
- Hydrocephalus: Due to obstructed CSF flow5.
- Rebleeding: Especially in untreated aneurysms8.
- Long-term deficits: Paralysis, cognitive impairment, epilepsy38.
Prevention
- Hypertension management: Regular monitoring and medication adherence38.
- Lifestyle modifications: Smoking cessation, alcohol moderation, weight control8.
- Avoidance of head trauma: Use of protective gear during high-risk activities3.
Intracranial bleeding is a life-threatening condition requiring urgent diagnosis and tailored treatment to optimize outcomes. Early recognition of symptoms (e.g., sudden headache, focal neurological deficits) and rapid imaging are critical148.
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References:
1 Cleveland Clinic, 2 Healthline, 3 MedPark Hospital, 4 Vejthani Hospital, 5 BMJ, 6 Vejthani (Non-Surgical Treatment), 7 NCBI Bookshelf, 8 Wikipedia, 9 Geeky Medics.
