Intracranial Hemorrhage

One of the most frightening and confusing birth injuries possible are brain bleeds or intracranial hemorrhages. These injuries occur during complications from labor delivery. They can minimal and heal completely but they can also be quite extensive and cause lifelong issues like cerebral palsy or even permanent brain damage. Often these hemorrhages are caused by doctor negligence during birth and delivery. The biggest contributors to this are the use of forceps, vacuum extractors, delivery room trauma and birth asphyxia or oxygen deprivation.

Brain bleeds occur within the skull. They can happen inside the brain itself or in the space between brain and the skull surrounding it. It can be especially dangerous if it is not detected immediately. Brain bleeds injure parts of the brain and can even kill parts of it which control motor functions and development which is why cerebral palsy is often an outcome.

These brain bleeds begin with a swelling of a portion of the brain called a intracranial hematoma, which is bleeding sequestered in a particular part of the brain. The collection of blood, or hematoma, compresses brain tissue and can cause death. Physicians must remove the clotted blood by surgical means or in some cases medication can alleviate the blood collection.

If not immediately recognized, brain bleeds can grow worse and be deadly. Symptoms in newborns include sharp crying, lethargy, discoloration of the skin, irregular blood count and strange eye movements. Recognizing these signs early on can save an infant’s life.

Premature infants may be particularly at risk for this malady as they are often delivered with the use of forceps or vacuum procedures. Hemophilia and vitamin K deficiency can sometimes lead to brain bleeds as well. Meningeal inflammation result in in non-obstructive hydrocephalus as the infant grows is also related to intracranial hemorrhage. The most common intracranial hemorrhages are at the subarachnoid space in the brain.

An unborn fetuses can be affected by intracranial hemorrhages complete with blood clotting and/or irregular blood vessel formation in the brain. Maternal hypertension or high blood pressure in the mother can also be a contributing factor.

Subdural hemorrhages occur when a rupture or tear of blood vessels in the subdural space. These are also caused by harsh deliveries such as with a larger than average baby. Cephalohematomas are another type of brain bleed. It occurs between the covering of the skull and the skull itself. Beginning as a raised bump on the baby’s head shortly after birth, it can last between 2 weeks to several months.

More often than needed, intracranial hemorrhages occur because of a mistake by a medical professional, making it exponentially harder to deal with by the parents and loved ones of the infants. While it can occur in utero from other circumstances, this doesn’t occur often. Large babies and/or mothers with smaller than average pelvises are most likely the next most common reason these bleeds occur. Breach births and facial presentations can also be a factor.

Types of Intracranial Hemorrhage

Intracranial hemorrhage or intracranial bleeding can happen in both the subarachnoid space or the subdural space. Subarachnoid hemorrhage is most common. It is bleeding in the space between the two membranes that cover the baby’s brain. It occurs in full term babies most often. Its most telling symptoms include apnea, seizure activity and lethargy. Hemorrhage in the subdural space or subdural hematoma, happen when a blood vessel in the space between the brains surface and the tissue that separates the skull from the brain ruptures. This can occur from a tear in the bridging veins inside the skull, the falx or the tentorium. Seizures most always occur. Acute subdural hematoma are especially deadly with a mortality rate of 4-% to 80%.

A cephalohematoma may also occur. It entails bleeding between the covering of the skull and the skull itself. It appears as a raised area or bump on the baby’s head. It goes away in most cases, usually after a few weeks but can last a few months. Another issue that occur is Hypoxia-ischema also known as cerebral hypoxia. This malady occurs when adequate oxygen is deprived to the entire brain without being a total deprivation.

The most serious type of intracranial hemorrhage is the intraventricular hemorrhage. Bleeding in the ventricular system of the brain, where spinal fluid is produced, is most often found in premature infants and those with low birth weight.

There are four varying degrees of intracranial hemorrhaging dependent on the severity of the bleeding.

Grade I – hemorrhage happens in the germinal matrix.

Grade II – hemorrhage happens in the germinal matrix as well as inside the ventricles.

Grade III – ventricles are enlarged by blood flow.

Grade IV – bleeding into brain tissue around the ventricles.

Causes of Intracranial Hemorrhage

Intracranial hemorrhages mean ruptured blood vessels inside the skull. This can happen in any number of ways including inadequate blood and oxygen flow to doctor negligence. The baby may be to large or the mother’s pelvis too small to make birth easy. A prolonged birth in itself can cause birth trauma. If a baby is born breech or in face presentation, there can also be an instance of intracranial hemorrhage.

Other instances can include:

  • Deviations in blood pressure
  • Pressures on the baby’s head during labor from forceps or other tools
  • The presence of the germinal matrix - embryonic cells in the brain from which neurons and glial cell are made
  • Hematologic disorders like a vitamin K deficiency, hemophilia, or disseminated intravascular coagulation
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