Intracranial Hemorrhages

What is an Intracranial Hemorrhage?

Intracranial hemorrhage (ICH) is bleeding inside the skull. It is a life-threatening emergency. If you think you or someone you know is experiencing ICH, go to the emergency room right away or call 911.

Types if ICH

There are four categories of ICH:

  • epidural hematoma
  • subdural hematoma
  • subarachnoid hemorrhage
  • intracerebral hemorrhage

Epidural Hematoma

This is when there is an accumulation of blood between the skull and the outermost covering of the brain.

It typically follows head injury and is characterized by high pressure bleeding. Someone suffering an epidural hematoma may briefly lose consciousness and then regain consciousness.

A hematoma is a collection of blood, in a clot or ball, outside of a blood vessel.

Subdural Hematoma

This is a collection of blood on the surface of the brain.

It is typically caused by head injury in which the head moved rapidly forward and stopped, like in a car accident. However, it could also suggest abuse in children, since this is the same type of movement a child might suffer when being shaken.

A subdural hematoma is more common than other ICHs in elderly and alcoholic people.

Subarachnoid Hemorrhage

This is when there is bleeding between the brain and the thin tissues that cover the brain. It has a genetic component—in other words, it tends to run in families.

A subarachnoid hemorrhage is usually preceded by a sudden, sharp headache. Typical symptoms also include loss of consciousness and vomiting. This type of ICH can be caused by alcohol or drug abuse.

Intracerebral Hemorrhage

This is when there is bleeding inside the brain. It is usually not the result of injury.

Intracerebral hemorrhage is characterized by sudden onset of neurological deficit (problems with brain function). The symptoms progress over minutes to hours, and include:

  • headache
  • nausea
  • vomiting
  • decreased consciousness
  • elevated blood pressure

What Are the Risk Factors for ICH?

Most ICHs are caused by a head injury.

Factors that increase your risk include:

  • family history of ICH
  • alcohol abuse
  • hypertension
  • cigarette smoking
  • use of certain drugs including amphetamines and MDMA (ecstasy)
  • extreme physical exertion

What Are the Signs and Symptoms of ICH?

Signs and symptoms of ICH vary depending on the type, but usually include:

  • headache, sudden and severe
  • headache, associated with a recent blow to the head
  • headache, mild and long-lasting
  • headache accompanied by neck stiffness
  • confusion
  • drowsiness
  • vomiting more than twice in 24 hours
  • seizure
  • coma

ICH and Children

ICH in a child can indicate child abuse. The damage may have been caused by a blow to the head or by shaking the child (which can lead to shaken baby syndrome—when violent shaking leads to serious brain damage in a child).

Other signs of child abuse are:

  • swollen head
  • retinal hemorrhages
  • vomiting
  • seizure
  • unconsciousness

Babies less than 12 months old may develop a swollen fontanelle (soft spot).

Report suspected child abuse right away by calling 911 or 1-800-4-A-CHILD(422-4453).

How Is ICH Diagnosed?

The first step in diagnosing ICH is a brain computed tomography (CT) scan. The doctor uses this to see abnormalities in the brain like swellings or clots. If there are no signs of ICH in the CT scan but the patient is still having symptoms, it may be necessary to test the fluid that cushions the spine and brain. This is done by lumbar puncture (spinal tap).

How Is ICH Treated?

ICH is a medical emergency. Survival depends on getting treatment right away.

It may be necessary to operate to relieve the pressure on the skull. Drilling a small hole in the skull releases blood. Drilling a larger hole may be necessary to remove a blood clot.


The following drugs may be prescribed:

  • steroids to reduce swelling
  • anticoagulants to reduce clotting
  • anti-seizure medicines

What Is the Outlook for Someone Who Has Experienced ICH?

The outlook for someone who has experienced ICH depends on how quickly medical care is received and on the severity of the hemorrhage. Remember, this is a life-threatening condition.

Depending on how severe the hemorrhage is, a person can recover once the hematoma has been drained. Sometimes, physical and/or occupational therapy are needed to help the person return to normal activities.

Long-Term Complications of ICH

Suffering an ICH can lead to any of following complications:

  • seizures
  • paralysis
  • headaches
  • brain development problems in children
  • memory loss
  • dizziness
  • difficulty concentrating

Tips to Prevent Head Injuries

Basic preventive measures that can help to avoid head injuries include the following:

  • Always wear a helmet when riding a bike, motorcycle, skateboard, or scooter.
  • Always wear your seatbelt.
  • If you are elderly, avoid falls.
  • Report suspected child abuse to 911 or 1-800-4-A-CHILD(422-4453).