When Your Child Has Intracranial Hemorrhage

Your child has an intracranial hemorrhage. This is bleeding that occurs in any part of the brain or between the brain and the skull. Bleeding can damage brain tissue. It can also lead to brain swelling or brain compression. If the bleeding is severe, treatment will be needed to limit brain damage or save your child’s life. Treatment may also reduce your child’s risk of having long-term brain (neurologic) problems.

Closeup view of arteriovenous malformation (AVM) in the brain. Closeup view of aneurysm in the brain.

What are the causes of intracranial hemorrhage?

These can include:

  • Trauma, such as a head injury

  • Problems with abnormal blood vessels in the brain, such as:

    • An abnormal formation of blood vessels (arteriovenous malformation)

    • A balloon-like bulge in the wall of a blood vessel in the brain (aneurysm)

    • Weakened blood vessels that occur with some brain tumors

  • Sickle cell disease

  • Medical diseases that make your child more prone to bleed (hereditary bleeding problems or liver problems)

What are the symptoms of intracranial hemorrhage?

Symptoms can include:

  • Sudden, severe headache

  • Dizziness or fainting

  • Trouble with vision, speech, or movement

  • Confusion, extreme irritability, or sudden personality change, or coma

  • Fever

  • Stiff neck

  • Seizures or convulsions

  • Nausea and vomiting

How is intracranial hemorrhage diagnosed?

Intracranial hemorrhage is an emergency. Your doctor will advise you to go to the closest emergency room for evaluation and treatment if intracranial hemorrhage is suspected. Your child may also be evaluated by a pediatric neurologist or neurosurgeon. These are doctors with special training to find and treat problems that affect the brain and nervous system. The doctor will ask about your child’s health history and symptoms. The doctor will also examine your child. Tests will be done as well. These can include:

  • MRI or CT scan. These provide detailed pictures of the brain. They are used to help check for bleeding. During the test, fluid called contrast dye may be used to make the blood vessels and brain easier to see.

  • Angiography. This test takes pictures of the blood vessels in the brain. During the test, a thin tube called a catheter is guided into the blood vessels leading to the brain. Contrast dye is sent through the tube to make the blood vessels easier to see. This test can also be done with an MRI or CT scan. this test is often replaced or preceded with MRI (magnetic resonance angiography) if available.

  • Transcranial doppler (TCD). This test shows the flow of blood through the blood vessels in the brain. It uses harmless sound waves to form pictures of the brain and blood vessels. It is used to monitor ongoing conditions that may worsen the bleeding.

  • Lab testing. Blood tests are done to identify risk factors include platelet count and other tests to measure blood clotting.

How is intracranial hemorrhage treated?

Treatment depends on the cause, size, and location of the bleeding. It also depends on your child’s overall health. Treatment can include:

  • Observation. Small amounts of bleeding will reabsorb naturally and does not require surgery. Your child may need to be observed in the hospital to watch for symptoms of worsening bleeding.

  • Medical management. Use of medicine to control the bleeding.

  • Medicine to prevent seizures.

  • Medicine to control blood pressure.

  • Surgery. This may be done to remove trapped blood or excess fluid in the brain.

  • Repair of abnormal blood vessels in the brain. This may involve surgery to clip or remove the abnormal blood vessel. Or a catheter can be used to insert glue, a coil, or a balloon into the abnormal blood vessel. This closes it off. This also helps reduce the risk of further bleeding.

What are the long-term concerns?

Each child’s outcome will vary depending on the size, cause, and location of the bleeding.  Some children do not have any problems after treatment. Other children may have ongoing neurologic problems. These can include trouble with seizures, learning, speech, or movement. In these cases, regular follow-up with the doctor are needed. Supportive care, such as speech, physical, or occupational therapy, may also be needed.