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Bleeding Within the Skull: Types, Causes, Treatment, Surgery, Recovery, Prognosis

What is Bleeding Within The Skull?

Bleeding within the skull is certainly a life-threatening emergency. In case you know someone is experiencing bleeding within the skull, call 911 right away or rush to the emergency room. There may be head injuries that results with a brief tumble, slip or loss of consciousness which may be minor, but bleeding within the skull is life-threatening and calls for immediate attention and treatment. Bleeding within the skull mostly, though not always, involves a surgery to remove the blood.

Bleeding Within the Skull

Children with Bleeding Within the Skull

Bleeding within the skull in a child refers to or might indicate child abuse. This damage may be a result of a blow on the head or even by shaking the child (that happens due to violent shaking of the child leading to shaken baby syndrome- causing serious brain damage in a child). Other child abuse signs are:

  • Vomiting.
  • Retinal hemorrhage.
  • Unconsciousness.
  • Swollen head.
  • Seizure.

Babies under 12 months may develop a soft spot, as swollen fontanel. You may right away call 911 or 1-800-4-A-CHILD (422-4453) and report child abuse, if you suspect any child.

Types of Bleeding Within the Skull

There are four types of bleeding within the skull:

  • Epidural bleeding.
  • Intracerebral bleeding.
  • Subarachnoid bleeding.
  • Subdural bleeding.
  1. Epidural Bleeding: This happens due to accumulation of blood between the brains outer covering and the skull. This is followed after a head injury and results in high pressure bleeding. People suffering from epidural bleeding lose consciousness briefly, but also regain consciousness. A hematoma represents a clot, a blood collection or ball, in the outside of blood vessel.

  2. Intracerebral Bleeding: This causes bleeding inside the brain. This type of bleeding within the skull is not caused due to any injury. Intracerebral bleeding refers to the sudden onset of problems in brain functioning and is characterized by neurological deficit. The symptoms here advance over minutes to hours, and include:

    • Vomiting
    • Nausea
    • Headache
    • Increase in blood pressure (B.P)
    • Decreased consciousness
  3. Subarachnoid Bleeding: This causes bleeding between the brain and its thin tissues covering the brain. It runs down in families as it is believed to have a genetic component. A subarachnoid bleeding is preceded by a sharp, sudden headache and the symptoms include vomiting and loss of consciousness. This type of bleeding within the skull can be caused due to drug or alcohol abuse.

  4. Subdural Bleeding: This causes collection of blood on the brain surface. It is caused absolutely due to head injury such that the head moves forward rapidly and stops. This type of bleeding within the skull mostly happens in a car accident. However, this happens in children as abuse as the same movement type is suffered by a child when they are shaken. A subdural bleeding is experienced by alcoholic and elderly people, besides this is common than all the other types of bleeding within the skull.

Causes of Bleeding Within the Skull

The bleeding within the skull is caused by a head injury. This is mostly a result of motorcycle, automobile or bicycle falls, accidents, sports injuries or assaults. Mild head trauma also causes a bleeding within the skull in an older adult, especially if you are already taking antiplatelet or anticoagulant drugs, namely aspirin. In case there is no bruise, open wound or damage sign visible outward, it is a serious injury.

Signs and Symptoms of Bleeding Within the Skull

Symptoms and signs of bleeding within the skull is evident immediately after a blow to your head, or sometimes it takes several weeks or even longer to appear. It appears to be fine after a head injury and this is the period known as the lucid interval. Conversely, overtime, pressure on your brain increases, and this result in the signs and symptoms:

  • Increasing headache is a symptom of bleeding within the skull.
  • Confusion.
  • Vomiting.
  • Increased blood pressure.
  • Progressive loss of consciousness is a sign of bleeding within the skull.
  • Drowsiness and dizziness.
  • Slurred speech.
  • Increased blood pressured.
  • Another indicator of bleeding within the skull is unequal pupil size.

As the space between your skull and the brain becomes narrow and more blood fills your brain, other symptoms and signs of bleeding within the skull become apparent, such as:

  • Unconsciousness
  • Seizures
  • Lethargy.

When to Rush a Doctor for Bleeding Within the Skull?

Bleeding within the skull is definitely life-threatening. It is mandatory to consider emergency medical treatment. Consider immediate medical attention on receiving a blow to the head if:

  • You have the symptoms and signs indicating an bleeding within the skull.
  • You are losing consciousness.

Symptoms and signs of bleeding within the skull do not come to notice instantly, so watch for subsequent mental, physical, and emotional changes. For instance, there may be people appearing normal after a head blow and they may also talk, but if they become unconscious later, seek immediate medical care, it is essential.

Even if you feel fine after a blow on the head, ask someone to have an eye on you. There may be memory loss if you receive a blow to your head such that it leads to forgetfulness eventually. Informing someone to have an eye on you may notice and recognize the warning signs of bleeding within the skull and this is sure to help you get timely and prompt medical attention.

Risk Factors for Bleeding Within the Skull

Head injury is the main reason to cause most bleeding within the skull. Factors increasing the risk include:

  • Bleeding within the skull in the family history is a factor of risk for bleeding within the skull.
  • Hypertension.
  • Alcohol abuse.
  • Smoking cigarette.
  • A major sign of bleeding within the skull is usage of drugs such as ecstasy (MDMA) and amphetamines.
  • High physical exertion.

Complications in Bleeding Within the Skull

Long-term bleeding within the skull difficulties or Complications include:

  • Concentration problems is a complication of bleeding within the skull.
  • Dizziness.
  • Seizures.
  • Headaches.
  • Memory loss.
  • Paralysis is a complication of bleeding within the skull.
  • Brain development problems in kids.

Tests to Diagnose Bleeding Within the Skull

It is difficult to diagnose an bleeding within the skull because individuals appear to be fine immediately after an injury. Nevertheless, doctors presume that after a head injury the progressive loss of consciousness is due to a bleeding within the skull until it is not proved as the else reason.

The best ways of imaging techniques to define the size and position of a hematoma include:

  • CT Scan for Bleeding Within the Skull: CT scan to diagnose bleeding within the skull involves using sophisticated X-ray machine associated to a computer that produces detailed images of your brain. The normal practice is to make a patient lie on a movable table and is guided into a large doughnut type machine and the images are captured. CT represents Computerized Tomography scan that is used commonly to imaging scan and to assess intracranial bleeding within the skull.
  • MRI Scan to Diagnose Bleeding Within the Skull: This is done using magnet and radio waves to make computerized images. Here also the patient is asked to lie on a movable table and is guided into a tunnel or tube. Generally, MRIs are used to diagnose the bleeding within the skull same as the CT scans. The MRIs represents Magnetic resonance imaging scan and it takes longer time to perform; besides the imaging is not always available perfectly. In difficult times, a 3T- MRI scan is used.

Treatment for Bleeding Within the Skull

There may be some bleeding within the skull that are really small and such cannot be removed; besides they show no symptoms or signs. The problem becomes serious when the symptoms and signs start appearing after the injury in few days or weeks. In such cases, though a patient does not undergo surgery, watching for neurological changes is essential so that you monitor intracranial pressure and repeated head CT scans are done.

If you are taking warfarin, blood-thinning medication, there is a need for the therapy to reverse the medication effects and to reduce further bleeding. The reversing blood thinners options include administering fresh frozen plasma and vitamin K.

Surgery for Bleeding Within the Skull

There is no doubt that bleeding within the skull treatment is often related to undergoing surgery. This surgery type is based on the bleeding within the skull characteristics. The options are:

  • Surgical Drainage to Treat Bleeding Within the Skull: In case there is no excessive clotting of blood or the blood is localized, your doctor will make a burr hole through your skull and remove the blood using suction.
  • Craniotomy to Treat Bleeding Within the Skull: Large hematomas involve opening of skull to remove the blood.

Recovery from Surgery for Bleeding Within the Skull

Surgery is inevitable for most bleeding within the skull and post-surgery, doctor prescribes for a year anticonvulsant drugs to prevent or control post-traumatic seizures.

There is a need for long term anticonvulsant in case the seizures continue. The other conditions experienced after surgery for some time include:

  • Difficulties in attention.
  • Amnesia.
  • Headaches.
  • Sleep Problems.
  • Anxiety.

Recovery can be prolonged after an intracranial bleeding and may be incomplete. In case one experiences neurological problems even after treatment, there is a need for occupational and physical therapy (PT).

Recovery Period/Healing Time for Bleeding Within the Skull

The recovery period/healing time for bleeding within the skull is based on the mode of treatment and only your doctor should provide you an approximate recovery time. Consult for the recovery time and also ask if there will be recurrence.

Prevention of Bleeding Within the Skull

Some times the prevention of bleeding within the skull is in our hands. Steps to minimize or prevent head injury:

  • Buckle seat belt and also buckle your kids. This minimizes head damage.
  • Wear helmet that fits properly while playing bicycling, skiing, motorcycling, skating, snowboarding, horseback riding, or doing any such activity that may cause head injury.
  • Use pad countertops and table edges, keep children away from unsteady objects or from climbing on unsafe places, thus prevent tipping from heights.

Coping with Bleeding Within the Skull

Coping after a surgery for bleeding within the skull is not easy and patience is the key. Adults recover in the first six months. Yet, there may be gradual improvements appearing even up to two years after the hematoma. Here are some useful coping tips to ensure recovery:

  • Adequate rest in daytimes and sleep at night is an excellent coping method for bleeding within the skull.
  • Avoid participating in recreational sports until you receive the OK confirmation from your doctor.
  • Get back to normal activities once you regain strength.
  • Another great way to cope is to avoid drinking alcohol as it may hinder recovery. You must recover completely and if you try drinking, it is sure to increase risk of another bleeding within the skull.
  • Check with your doctor prior to beginning driving, riding a bicycle, playing sports or even machine operating. The reaction times may have slowed due to this bleeding within the skull.
  • Talk with friends or trusted family members prior to taking any decision.
  • If you have trouble in recalling, write down a list of things to do.

Prognosis/Outlook for Bleeding Within the Skull

The prognosis/outlook for bleeding within the skull depends on the speed the medical attention is received and on the hemorrhage severity, as it is a crucial condition.

Depending on the bleeding severity, a person recovers as the hematoma is drained. Sometimes, there may be the need for physical or/and occupational therapy to help a person return to normal activities.


  1. Ropper AH. Intracerebral Hemorrhage. N Engl J Med. 2020;382(1):60-67. doi:10.1056/NEJMcp1808492
  2. National Institute of Neurological Disorders and Stroke. Traumatic Brain Injury: Hope Through Research. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Traumatic-Brain-Injury-Hope-Through.
  3. Mayo Clinic. Subdural Hematoma. https://www.mayoclinic.org/diseases-conditions/subdural-hematoma/symptoms-causes/syc-20355512.
  4. National Library of Medicine. Shaken baby syndrome. https://medlineplus.gov/ency/article/001554.htm.
  5. National Library of Medicine. Epidural Hematoma. https://medlineplus.gov/ency/article/000792.htm.
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 5, 2023

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