View source for Traumatic intracerebral hemorrhage

==Background==
*The pathological accumulation of blood within the cranium.
**May occur within the brain parenchyma or the surrounding meningeal spaces.

{{Intracranial hemorrhage DDX}}

==Clinical Features==
[[File:TBI GCS.jpg|thumb|Distribution of GCS in [[traumatic brain injury]]]]
{{GCS table}}

==Differential Diagnosis==
{{Head trauma DDX}}
{{Maxillofacial trauma DDX}}

==Evaluation==
[[File:Traumatische SAB 001 Kontrolle mit Aufbluehen.png|thumb|Traumatic subarachnoid hemorrhage on CT with additional intraparenchyma hemorrhage (arrow): so-called “blooming” of the contusion.]]
*Monitor for [[elevated ICP|increased ICP]] 
**[[headache]], [[nausea and vomiting]], [[seizure]], [[lethargy]], [[hypertension]], [[bradycardia]], agonal respirations, posturing
*Monitor for [[herniation Syndromes|herniation]]
**Ipsilateral fixed and dilated pupil
**Contralateral motor [[weakness|paralysis]]
*Bilateral pinpoint pupils suggests opiate use or pontine lesion

{{Head trauma workup}}

==Management==
*Pretreatment with lidocaine has not been shown to improve outcomes 
*Seizure prophylaxis in Head Trauma]]
*[[Management of Elevated Intracranial Pressure]]

===Prevent further brain injury===
*Head of bed at 30 degrees 
*Prevent: 
**[[Hypotension]]
**[[Hypoxia]] 
**[[Anemia]] 
**[[Hyperthermia]] 
**[[Coagulopathy]]
**[[Seizure]]

{{ICH Treatment}}
{{Increased ICP treatment}}

==Disposition==
*Admit (most frequently to ICU)

==Prognosis==
===Repeat Imaging in Traumatic Subarachnoid Hemorrhage<ref>Borczuk, et al. Patients with traumatic subarachnoid hemorrhage are at low risk for deterioration or neurosurgical intervention.  J Am Coll Surg.  2014; 219.</ref><ref>Nahmias JT, et al.  Mild Traumatic Brain Injuries Can Be Safely Managed Without Neurosurgical Consultation: The End of a Neurosurgical "Nonsult"? American Association for the Surgery of Trauma.  Annual Meeting.  2016</ref>===
*Patients with normal neurologic exam NOT on anticoagulation do not need a repeat head CT
**Recommend 6 hour observation
*Patients with GCS 13 or higher may not need a NSGY consult, regardless of antiplatelet or anticoagulation, as long as agent properly reversed

==See Also==
*[[Head trauma (main)]]

==References==
<references/> 

[[Category:Trauma]]
[[Category:Neurology]]