What is an Intracranial Hemorrhage?
Doctors use the term “intracranial hemorrhage” to indicate bleeding within the brain or between the brain and the skull. A severe intracranial hemorrhage can cause permanent brain damage and lifelong health issues.
Like other kinds of internal bleeding, intracranial hemorrhages are dangerous because you may not know right away what has occurred. Intracranial hemorrhages can injure or kill parts of the brain that control development and motor function. Therefore, they often lead to cerebral palsy if they are not caught and treated quickly.
Many issues can cause an intracranial hemorrhage, with head trauma being the most common cause for people under 50. Infants may also be at a higher risk of intracranial hemorrhaging.
During birth, an infant can experience an intracranial hemorrhage from complications during delivery. An unborn fetus could be affected by problems with blood clotting or irregular blood vessel formation in the brain. They can also be impacted by maternal hypertension (high blood pressure in the mother). In the chaos of the delivery room, medical experts may not notice an intracranial hemorrhage.
Checking for an intracranial hemorrhage as a cerebral palsy or birth injury factor directly after birth is recommended.
Symptoms of an intracranial hemorrhage in an infant include:
- Sharp crying
- Skin discoloration
- Changes in blood count
- Irregular eye movement
An intracranial hemorrhage can cause localized swelling in the brain called an intracranial hematoma. This occurs when the bleeding is isolated in a particular part of the brain and the blood pushes down on brain tissue.
A hematoma is a lump or clot of damaged blood cells. When an intracranial hematoma occurs, it is possibly life-threatening and should be treated immediately. If left untreated, serious complications can result from an intracranial hematoma.
Doctors may prescribe medication or perform surgery to remove the collected blood and alleviate pressure on the brain.
An intraventricular hemorrhage (IVH) in new babies occurs when blood gets into or between the ventricles (hollow spaces) in the brain. Blood should not flow back into the ventricular system. If it does, it can cause severe brain damage or cerebral palsy.
According to the National Institutes of Health (NIH), intraventricular hemorrhages are ranked in four grades. The higher the grade, the worse the bleeding.
The four grades are:
- Grade 1: The bleeding is contained to the germinal matrix or periventricular areas of the brain. It is also called a germinal matrix hemorrhage.
- Grade 2: The bleeding extends into ventricles (hollow spaces) in the brain but they do not dilate.
- Grade 3: The amount of blood in the ventricles makes them swell up.
- Grade 4: The bleeding reaches the brain tissue. This is also called a periventricular hemorrhage (PVH). It presents the highest risk of permanent damage.
Grades 1 and 2 do not typically cause complications. Grades 3 and 4 are the most serious and may result in long-term brain injury or an intraventricular hemorrhage causing cerebral palsy.
Premature babies are at the highest risk of an intraventricular hemorrhage, especially those weighing less than 3 pounds and 4 ounces. They are at high risk because they have many fragile blood vessels in the brain that can be easily harmed by the delivery process and/or respiratory distress.
About 25% of preterm infants will experience an intraventricular hemorrhage.
The best way to prevent an intraventricular hemorrhage is to prevent premature birth. Mothers who are at risk of premature delivery are often given antenatal steroids to assist with fetal lung maturity. This helps to decrease the infant’s risk of respiratory distress syndrome, which can lead to hemorrhages.
Intraventricular hemorrhages can be diagnosed by a cranial ultrasound or CT scan. An ultrasound of the head is recommended for all babies born before 30 weeks of pregnancy. It is performed between 1 to 2 weeks of age and repeated around the baby’s originally expected due date.
Additionally, a lumbar puncture tests the baby’s spinal fluid for high protein concentrations and red blood cells, which are present in infants who have suffered an intraventricular hemorrhage.
Symptoms of an Intraventricular Hemorrhage
These are several telltale symptoms of an intraventricular hemorrhage. Each baby may experience symptoms differently.
These symptoms include:
- Stopping breathing (apnea)
- Low heart rate
- Pale or blue coloring
- Weak suck
- High-pitched cry
- Seizures, swelling or bulging of the “soft spots” on the baby’s head
- Low blood count
A blood transfusion may improve blood pressure and blood count. Surgery may be needed to relieve some pressure on the brain. How well an infant does depends on the amount of bleeding and swelling.
Regular doctor’s visits are recommended for several years after a diagnosis of an intraventricular hemorrhage to monitor for complications.
An intracerebral hemorrhage is a severe stroke within the brain. A stroke is sometimes called a “brain attack.”
Intracerebral hemorrhages can cause irreversible brain damage, severe disability or death if they are not caught and treated early.
The general public usually associates strokes with adults, especially the elderly. However, strokes can occur at any age. A fetus, newborn, infant or young child may be at risk of suffering a stroke.
Strokes can happen when a clot or other obstruction blocks a blood vessel. Strokes can also occur when a blood vessel inside the brain bursts. In an intracerebral hemorrhage, blood spills into the spaces around the cells and damages them. If the hemorrhage damages the areas of the brain that control movement, the result could be partial or total paralysis.
Strokes occur in about 1 in every 3,000 births, either during pregnancy or through the early newborn period. Children with hematological disorders such as sickle cell disease are at higher risk for strokes.
A subarachnoid hematoma is a very dangerous condition where blood collects under the arachnoid mater, the thin membrane that covers the brain.
A subarachnoid hematoma can lead to numerous complications, including strokes, seizures or death. A subarachnoid hematoma can also cause cerebral palsy when this abnormal bleeding damages the brain. This is especially true for babies who suffer traumatic brain injuries.
Subarachnoid hematomas and cerebral palsy are diagnosed primarily through brain imaging scans such as a cranial ultrasonography. The prognosis depends on where and how the damage is done, but it is often not good.
For babies born with subarachnoid hematoma causing cerebral palsy, the chances of leading an independent life are severely compromised. A baby born with cerebral palsy caused by a subarachnoid hematoma will often need lifelong medical care and assistance.
A subdural hematoma is a very serious condition usually caused by a head injury. In a subdural hematoma, tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect.
This can happen to a baby during gestation or delivery and can sometimes be the result of medical negligence. Subdural hematomas can cause cerebral palsy when this bleeding damages the brain.
Subdural hematomas and cerebral palsy are diagnosed primarily through brain imaging studies such as cranial ultrasonography. Much like subarachnoid hematomas, subdural hematomas can cause extreme, irreversible damage.
A baby born with cerebral palsy caused by a subdural hematoma will most likely need medical care and assistance throughout their lifetime. For many families, paying for special medical treatment and caregivers can be challenging and stressful.
Epidural hematomas are caused by strokes. In an epidural hematoma, the clot is located between the insides of the skull or spinal bones and the outer “skin” covering the brain or spinal cord.
Blood that escapes from channels or gets clotted in the brain can damage neurons that control muscles and movement control. Damage to these cells results in cerebral palsy.
In babies, a stroke may occur during pregnancy, labor, delivery or the period shortly after birth. A stroke in a baby attacks a brain that has not finished growing. If not treated in time, a baby may develop an epidural hematoma and/or cerebral palsy.