Traumatic intracranial hemorrhage [Neurosurgery Wiki]

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====== Traumatic intracranial hemorrhage ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1hc_GSJf8Nhkh9g_4bMbl_7Hn5Qi__vWo8sQ9pUXMfQ_IiQQvI/?limit=15&utm_campaign=pubmed-2&fc=20230604031909}}

===== Classification =====

[[Traumatic intracranial hemorrhage classification]].

===== Risk factors =====

1. **[[Age]]**: Older adults, particularly those over 60, are at higher risk due to increased brain fragility and higher likelihood of taking anticoagulants.
   
2. **[[Severity]] of Trauma**: Severe head injuries, such as those from motor vehicle accidents, falls from height, or violent trauma, are more likely to cause ICH.

3. **Use of [[Anticoagulant]] or [[Antiplatelet]] Medications**: Blood thinners like warfarin, aspirin, or clopidogrel can increase the risk of bleeding after head trauma.

4. **Alcohol or Drug Use**: Chronic alcohol abuse or drug use can increase susceptibility to brain injuries and bleeding.

5. **Pre-existing Health Conditions**:
   - **Hypertension**: Long-standing high blood pressure can weaken blood vessels, increasing the likelihood of a hemorrhage after trauma.
   - **Coagulopathies**: Any condition that affects the body's ability to clot blood can increase the risk of bleeding, such as hemophilia or liver disease.

6. **Recurrent Head Injuries**: Athletes involved in contact sports (e.g., football, boxing) or individuals with repeated falls have a higher risk of developing ICH.

7. **Skull Fractures**: A fracture in the skull increases the likelihood of bleeding within the brain or surrounding areas.

8. **Low Platelet Count (Thrombocytopenia)**: Reduced platelets, critical for blood clotting, increase the risk of hemorrhage even with minor trauma.

Monitoring patients with these risk factors closely after head trauma is essential to ensure timely diagnosis and treatment.

===== Management =====

A definitive consensus on the standardization of practice of a routine repeat head [[CT]] (RHCT) scan in patients with traumatic intracranial hemorrhage is lacking. 

In a 3-year prospective cohort analysis of patients aged 18 years and older, without antiplatelet or anticoagulation therapy, presenting to a level 1 trauma center with intracranial hemorrhage on initial head CT and a follow-up RHCT. Neurosurgical intervention was defined by craniotomy/craniectomy. Neurologic deterioration was defined as altered mental status, focal neurologic deficits, and/or pupillary changes.

A total of 1,129 patients were included. Routine RHCT was performed in 1,099 patients. The progression rate was 19.7% (216 of 1,099), with subsequent neurosurgical intervention in 4 patients. Four patients had an abnormal neurologic examination, with a Glasgow Coma Scale (GCS) of ≤8 requiring intubation. Thirty patients had an RHCT secondary to neurologic deterioration; 53% (16 of 30) had progression on RHCT, of which 75% (12 of 16) required neurosurgical intervention. There was an association between deterioration in neurologic examination and need for neurosurgical intervention (odds ratio 3.98; 95% CI 1.7 to 9.1). The negative predictive value of a deteriorating neurologic examination in predicting the need for neurosurgical intervention was 100% in patients with GCS > 8.

Routine repeat head CT scan is not warranted in patients with normal neurologic examination. Routine repeat head CT scan does not supplement the need for neurologic examination for determining management in patients with traumatic brain injury
((Joseph B, Aziz H, Pandit V, Kulvatunyou N, Hashmi A, Tang A, Sadoun M,
O'Keeffe T, Vercruysse G, Green DJ, Friese RS, Rhee P. A three-year prospective
study of repeat head computed tomography in patients with traumatic brain injury.
J Am Coll Surg. 2014 Jul;219(1):45-51. doi: 10.1016/j.jamcollsurg.2013.12.062.
Epub 2014 Mar 1. PubMed PMID: 24745622.)).


----

Emergency department (ED) management of [[mild traumatic brain injury]] (TBI) with any form of [[traumatic intracranial hemorrhage]] (ICH) is variable. 

Since 2000, center's standard practice has been to obtain a repeat head computed tomography (CT) at least 6 hours after initial imaging. Patients are eligible for discharge if clinical and CT findings are stable. Whether this practice is safe is unknown
((Kreitzer N, Lyons MS, Hart K, Lindsell CJ, Chung S, Yick A, Bonomo J. Repeat
neuroimaging of mild traumatic brain-injured patients with acute traumatic
intracranial hemorrhage: clinical outcomes and radiographic features. Acad Emerg 
Med. 2014 Oct;21(10):1083-91. doi: 10.1111/acem.12479. PubMed PMID: 25308130.)).

===== Complications =====
No evidence is available on the risks of neurologically asymptomatic minimal [[traumatic intracranial hemorrhage]] (mTIH) in patients with [[traumatic brain injury]] (TBI) for [[posttraumatic headache]] (PTH).

Moderate-to-severe PTH can be expected after TBI in patients with mTIH and posttraumatic seizure. PTH occurs more frequently in patients with mTIH than in those without mTIH. 

===Progressive hemorrhagic injury (PHI)===

[[Progressive hemorrhagic injury]]


===== References =====