From the Guidelines
Intracranial hematomas can be broadly categorized into four main types: noncoagulopathic spontaneous intracranial hemorrhage, coagulopathic spontaneous intracranial hemorrhage, noncoagulopathic traumatic intracranial hemorrhage, and coagulopathic traumatic intracranial hemorrhage, each with distinct pathobiology and management considerations. These categories are based on the underlying cause of the bleeding, whether it is spontaneous or traumatic, and the presence or absence of coagulopathy, as outlined in a consensus statement published in the JAMA Network Open in 2021 1. The main difference between these categories lies in their tempo and pathobiology, with spontaneous bleeding often being hyperacute and traumatic bleeding occurring over a more prolonged time window, as noted in the same study 1. Some key points to consider when evaluating intracranial hematomas include:
- The risk of hematoma growth and expansion, which varies by location and presence of coagulopathy 1
- The timing of baseline computed tomography (CT) scans, which can impact the risk of progressive bleeding 1
- The potential for combining categories when evaluating reversal agents for specific forms of anticoagulation, such as vitamin K antagonists and antiplatelet agents 1
- The importance of prompt diagnosis and management to prevent increased intracranial pressure and potential brain herniation, which can be fatal if not properly managed. In clinical practice, it is essential to consider these factors when evaluating and managing patients with intracranial hematomas, as the outcome can significantly impact morbidity, mortality, and quality of life.
From the Research
Types of Intracranial Hematomas
Intracranial hematomas are categorized into four main groups based on the location of bleeding:
- Epidural hematoma
- Subdural hematoma
- Subarachnoid hematoma
- Intraparenchymal hematoma
Characteristics of Each Type
- Epidural hematoma: typically caused by traumatic lesions of meningeal arteries, which can lead to space-occupying hemorrhages with an intradural extent 2
- Subdural hematoma: a common type of intracranial hematoma, especially in older adults, which can be caused by traumatic intracranial aneurysm (TICA) 3 or other factors
- Subarachnoid hematoma: can be associated with primary and secondary tumors, as well as traumatic injuries 4
- Intraparenchymal hematoma: can also be associated with primary and secondary tumors, and is a type of hemorrhage that occurs within the brain tissue itself 4
Clinical Significance
The diagnosis and management of intracranial hematomas are critical, as they can be life-threatening conditions. Clinicians must recognize the typical presentations and order diagnostic imaging studies to make a timely diagnosis and referral to neurosurgery for definitive treatment 5. The timing of operative intervention for clot removal can also impact outcomes, although the extent of primary underlying brain injury is a more important factor in dictating outcome 6.