Sign Up for a Free Account
  • Updated 12.28.2023
  • Released 08.28.1996
  • Expires For CME 12.28.2026

Traumatic intracerebral hemorrhage



Intracerebral hemorrhage is a common complication of traumatic brain injury. Traumatic brain injuries can be classified into three major groups: closed head injury, penetrating injury, and explosive blast injury. Blast injuries appear to have a high risk for traumatic pseudoaneurysm formation. Differentiation between an intracerebral hemorrhage and a hemorrhagic contusion is difficult. Glasgow Coma Scale is the most valuable tool to assess the level of consciousness after traumatic brain injury. Intracranial hemorrhage in patients with traumatic brain injury results in poor neurologic outcomes and high mortality. In severe head injury, a hematoma of more than 50 mL is associated with higher mortality. Brain edema is a very significant independent prognostic variable across all categories of traumatic brain injury severity. Traumatic intracerebral hemorrhage, like spontaneous hemorrhage, often expands over time. The contrast extravasation, on multidetector CT angiography, is a strong and independent predictor of hematoma expansion, poor outcome, and increased risk of in-hospital mortality. Intraventricular hemorrhage on initial CT predicts lesions of diffuse axonal injury in the corpus callosum. Coagulopathies are common in patients with severe head injuries and contribute to hematoma formation. Approximately, 10% of patients with traumatic brain injury are likely to develop acute kidney injury, and many of them require kidney replacement therapy. Acute kidney injury adversely affects the outcome. The patients taking antiplatelet and anticoagulant drugs are at greater risk of intracranial hemorrhage, and treatment should include immediate withdrawal of these drugs. Effective neurocritical care coupled with timely and appropriate neurosurgical intervention can significantly improve outcomes. Bilateral fixed dilated pupils generally indicate a grave prognosis. Aggressive decompressive craniectomy in some of these patients improves the chances of a favorable outcome. Many patients, even with a Glasgow Coma Scale of 3, may have a good outcome at 6 months. Tranexamic acid is a promising drug that can be used to lower mortality. Genetic abnormities have been identified as a risk factor for hematoma expansion in patients with traumatic brain injury. Trials targeting these genes are currently ongoing, and they may open avenues for targeted treatment. Several studies have utilized machine learning algorithms to accurately predict outcomes in patients with traumatic brain injury, demonstrating the potential of machine learning in improving traumatic brain injury prognostication and treatment planning. In this article, the author discusses the pathophysiology, clinical presentation, impact on outcomes, and available treatments for traumatic intracerebral hemorrhage.

Key points

• Traumatic intracerebral hemorrhages result from either nonpenetrating or penetrating trauma to the head.

• A contusion consists of blood intermixed with brain tissue.

• Data have shown that traumatic intracerebral hemorrhages often expand over time.

• Delayed posttraumatic hemorrhages may sometimes result from coalesced blood within contusions.

• Therapeutic interventions that are frequently used include the administration of hypertonic saline, hyperoxygenation, decompressive craniectomy, and hypothermia.

• Mortality rates in severe traumatic brain injury are very high.

• Use of helmets, seat belts, and airbags has been shown to reduce fatal and serious head injuries.

Historical note and terminology

Traumatic head injury has been noted in human civilization for 3000 years. Descriptions of head injuries are available in ancient Sumerian, Egyptian, and Greek medicine. Hippocrates suggested that head injury in which the cranium was perforated might be followed by serious consequences, such as the extravasation of blood. Hippocrates’ treatise On Wounds in the Head represents an excellent classical source of information about head injury (69). The first description of gunshot wounds to the head was by Brunschwig, a German surgeon (11; 58). Cushing in his classical article of 1917 described varieties of missile injuries (20). Surgical treatment of traumatic intracerebral lesions was advanced in the late 19th and 20th centuries by several pioneer neurosurgeons, including Victor Horsley, Harvey Cushing, W H Jacobson, Hugh Cairns, and Walter Dandy. In 1974, the Glasgow Coma Scale (GCS) was first used as a functional scale for the assessment of coma and impaired consciousness (Teasdale and Jennet 1974). The development of brain CT allowed improvements in the diagnosis and characterization of traumatic intracerebral hemorrhage, and the traumatic brain injury field is being further revolutionized by the development and refinement of brain MRI (57).

This is an article preview.
Start a Free Account
to access the full version.

  • Nearly 3,000 illustrations, including video clips of neurologic disorders.

  • Every article is reviewed by our esteemed Editorial Board for accuracy and currency.

  • Full spectrum of neurology in 1,200 comprehensive articles.

  • Listen to MedLink on the go with Audio versions of each article.

Questions or Comment?

MedLink®, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660



ISSN: 2831-9125