Hemorragia intracraneal

An intracranial hemorrhage is bleeding inside the skull, usually from a torn or burst blood vessel, that allows blood to leak in or around the brain and press on brain tissue. It is a type of stroke and can be life‑threatening, but outcomes vary widely based on size, location, cause, and how fast treatment starts.

1) What is this condition?

It means there is blood where it should not be inside the head—either within the brain tissue itself or in the spaces around the brain.
It can be caused by high blood pressure, head injury, abnormal blood vessels, blood‑thinning medicines, or bleeding disorders.
Common symptoms include sudden headache, weakness, trouble speaking, confusion, vomiting, seizures, or loss of consciousness.

2) How serious is it?

This is a medical emergency; some types are among the deadliest forms of stroke, especially large bleeds deep in the brain.
About 25–40% of people with bleeding inside the brain die within the first month, but many survivors can regain independence over time.
Severity depends on bleed size, location, age, other illnesses, and whether there is swelling or pressure on vital brain areas.

3) Non‑surgical treatments

Emergency care to stabilize breathing, heart function, and blood pressure.
Quickly lowering very high blood pressure to a safer range to reduce further bleeding.
Stopping or reversing blood‑thinning drugs (like warfarin, some newer blood thinners, or strong aspirin‑type drugs).
Managing brain pressure with head positioning, fluids, medicines, and sometimes a drain.
Preventing and treating complications such as seizures, fever, high blood sugar, chest infections, and blood clots in the legs.
Starting early physical, occupational, and speech therapy once stable to support recovery.

4) Types of surgery that may be needed

Open surgery to remove a blood clot (hematoma) pressing on brain tissue, usually through an opening in the skull.
Minimally invasive surgery using small tubes and suction (with or without clot‑dissolving medicine) to clear blood from inside the brain.
Surgery to place a drain into the fluid spaces of the brain if blood is blocking fluid flow and causing pressure (often for bleeding into the brain’s ventricles).
In some cases (e.g., trauma, aneurysm, AVM), additional procedures to repair the underlying cause of bleeding.

5) Goals of surgery vs non‑surgical care

Non‑surgical goals:
- Keep the person alive and stable by protecting the brain from low oxygen, low blood pressure, and rising pressure.
- Limit the bleed from expanding and prevent medical complications that could worsen outcome.
Surgery goals:
- Remove enough blood and relieve pressure so that healthy brain is not crushed.
- Restore fluid flow inside the brain and reduce the risk of further damage or death.

6) How surgery can “fix” the problem

By taking out the pooled blood, surgery reduces the mass effect—the squeezing of brain tissue by the clot.
Minimally invasive techniques can shrink clot size quickly, which has been linked to better survival and function in some studies.
Draining blood‑stained fluid from the brain’s ventricles can lower pressure and help protect deep brain structures.

7) Risks of surgery (general and specific)

General risks: bleeding, infection, blood clots, and anesthesia problems.
Brain‑specific risks:
- Worsening weakness, speech, vision, or thinking if healthy tissue is injured during clot removal.
- Incomplete clot removal or re‑bleeding, requiring further surgery or prolonged intensive care.
- Drains can clog or cause infection, including serious brain infections.

8) Chances this surgery will work

Surgery can be life‑saving in selected patients, especially with large, accessible clots and worsening pressure.
Recent trials of early minimally invasive clot removal show better survival and improved function at 6 months for some patients compared with medical care alone.
However, surgery does not guarantee good recovery; some survivors have significant disability, and careful selection is critical.

9) Possible complications from the surgery

Re‑bleeding into the same area or new bleeding elsewhere in the brain.
Infections such as meningitis or abscess, especially if drains or tubes remain in place.
Long‑term problems with movement, language, memory, behavior, or mood that may require ongoing therapy and support.

10) Typical recovery from the condition

Recovery is often slow; gains can continue for many months, sometimes up to a year or more.
About half to two‑thirds of survivors eventually become independent in basic daily activities, though some remain significantly disabled.
Early, intensive rehab is linked with better walking, arm use, and self‑care, but fatigue and cognitive changes may persist.

11) Typical recovery after surgery

Early days: intensive care monitoring, possible ventilator support, frequent checks of strength and alertness.
First weeks: gradual weaning from tubes and machines, starting sitting, standing, and simple exercises as soon as safely possible.
Later months: inpatient or outpatient rehab focusing on walking, arm and hand use, speech, memory, and problem‑solving.

12) How long in the hospital

Many patients spend several days to a few weeks in the hospital, often with some of that time in intensive care.
After acute care, many transfer to a rehab hospital or skilled nursing facility before finally going home.

13) Long‑term outlook

Survivors have higher long‑term risks of another brain bleed, other strokes, and heart‑related events than the general population.
Survival remains lower than average for many years, but many people regain meaningful independence and return home.
Strict control of blood pressure and other risk factors is crucial to lower the chance of another bleed.

14) Need for outpatient follow‑up

Ongoing follow‑up with stroke/brain specialists and primary doctors is essential to adjust medicines and manage blood pressure and other risks.
Regular rehab visits (physical, occupational, speech therapy) may continue for months to optimize recovery.
Some patients need long‑term monitoring for mood, thinking changes, seizures, and caregiver support.