Evaluation of Head Bleeds (Intracranial Hemorrhages)

Overview of Intracranial Hemorrhage

HTRS 2015 (New Orleans, April 16-18) A session at Hemostasis and Thrombosis Research Society (HTRS) 2015 Meeting provided an overview of intracranial hemorrhages including: classifications, risk factors, management, and standard follow up recommendations. Intracranial hemorrhages, also known as head bleeds, have four different classifications; they are classified based on their location relative to brain or the skull. An epidural hematoma is a collection of blood that occurs between the skull and brain covering called dura; a subdural hematoma is a collection of blood that occurs between the dura and the brain surface; a subarachnoid hemorrhage is bleeding that occurs right at the brain surface, and an intracerebral hemorrhage is bleeding within the brain tissues.

The symptoms of a head bleed include a severe headache that does not get better for a long time, the feeling of tiredness or sleepiness, difficulty walking and other movement problems, nausea, vomiting, visual problems, seizures and dizziness. The risk factors for the development of a head bleed depend on the age of the patient.  About 15-33% of the bleeds occur during the neonatal period (birth to 28 days).  Some of the causes of bleeding include an injury related to birth or an invasive procedure before the baby is diagnosed. To manage head bleeds in a patient with hemophilia, replacement therapy is recommended for up to 21 days. If not treated, there could be severe consequences such as seizures, developmental and learning problems, cerebral palsy, and recurrent bleeds.   There are no current standard follow up recommendations available for head bleeds so patients should undergo regular developmental screenings to make sure they are reaching the appropriate milestones. In addition, more sensitive testing such as neuropsychological testing may be used to screen for subtle symptoms of head bleeds.