An intracranial hemorrhage (ICH) can affect anyone, from newborn babies to adults. It is a type of bleeding that occurs inside the skull; a blood vessel can leak or rupture under the skin, within the tissue layers surrounding the brain, or inside the brain itself. According to Emergency Medicine Clinics of North America, there are 40,000 to 67,000 cases in the U.S. every year and, worldwide, it occurs in 24.6 per 100,000 person-years.Get A 100% Free CASE Evaluation
Hemorrhages are a serious concern for newborn babies. Despite many studies on the subject, it is not known how many cases of perinatal intracranial hemorrhage occur, but tests such as CT scans are making it easier to diagnose them early. The bleeding is often localized, classifying it as a focal brain injury. Intra-axial bleeds, otherwise known as cerebral hemorrhages, occur within the brain and sometimes within the cellular tissues. These are more dangerous for the individual.
By comparison, an extra-axial bleed is easier to treat. It occurs outside the brain but inside the skull. An epidural bleed involves the dura mater and lies between this outer meningeal layer and the skull bone. Trauma is the most common cause of this. It is especially dangerous because the middle meningeal artery is often the site of damage, and blood here flows at high pressures. A subdural bleed happens between two layers called the dura and arachnoid mater. The bleeding typically looks crescent-shaped on a CT scan.
Further classifications indicate locations such as the deeper meningeal layers. Subarachnoid bleeding is not necessarily in the brain but can put pressure on the pia layer that directly surrounds it. Blood can seep into the brain along fissures and other structures. Subdural hematomas happen because a bridging vein has torn; this vessel runs between a draining venous sinus and the cerebral cortex. A lacerated artery on the brain surface may be the cause too.
It’s not always known why the problem occurs. Hemorrhaging is more common in premature babies, because the brain and blood vessels are more fragile. Therefore, they can easily rupture even without any kind of trauma. Intracranial bleeding is more often seen with co-occurring problems such as respiratory distress. In particular, an intraventricular hemorrhage (IVH) is more likely the smaller and earlier a premature infant is born; most of the time it occurs within the first few days.
Intracranial bleeding can cause severe damage to nerve cells because it can deprive them of oxygen and put extreme pressure on neural structures. Brain injury can result and is often permanent, leading to long-lasting developmental and functional disabilities. The scale of IVH varies and is classified into four grades. Grade 1 involves just a small, localized area, but Grade 2 is noted for blood collecting inside the ventricles. By Grade 3, these have already enlarged due to the volume of blood within them. In Grade 4, blood has entered the tissues of the brain surrounding the ventricles.
Some cases have few or no symptoms. The typical signs a baby may have IVH include apnea, or a temporary cessation of breathing, and a low heart rate. These two put together indicate a condition known as bradycardia. A baby may have a high-pitched cry, weak sucking reflex, or seizures. One may also notice that the soft spots, or fontanelles, on the head are bulging or appear swollen. Low blood counts signaling anemia may be found as well.
A physical exam can point to general symptoms, but a more accurate diagnosis can be made by conducting tests such as ultrasound, which can provide a view of the brain’s interior if used near the fontanelles. Other tests include scans such as an MRI or CT scan.
There’s no specific treatment for all cases. Surgery, medication, or no intervention may be required. It is often necessary to address the health problems that accompany a hemorrhage. Physicians have tried measures to prevent intracranial bleeding, such as corticosteroids. These may be prescribed to women who doctors think are at risk to deliver the baby early. Each case of ICH is unique to the individual, and the outcome of more severe cases is unpredictable, while mild forms of bleeding under the skull may resolve on their own without treatment.