Post-Traumatic Intracranial Hemorrhage: Follow-Up Care and Concerns

Follow-up for traumatic intracranial hemorrhage?

On May 22, my mother was involved in a car accident and was sent to the hospital.
She suffered a right skull fracture, traumatic intracranial hemorrhage, subarachnoid hemorrhage, subdural hematoma, and contusion with hemorrhage in the left hemisphere of the brain.
Since the accident occurred in Tainan, she was admitted to Chi Mei Medical Center, where she spent 6 days in the intensive care unit and 13 days in a regular ward.
The doctors assessed her condition and decided against surgery at that time.
Today marks the 22nd day since the accident.
Aside from occasionally forgetting names or how to refer to objects, experiencing a sense of unreality when looking at things (though her vision is clear), and feeling dizzy when lying down, her past memories and walking abilities seem relatively normal.

Since we live in the northern part of Taiwan, we have re-registered at Taipei Veterans General Hospital and would like to inquire about whether she needs ongoing follow-up or medication.
The doctor mentioned that dizziness and headaches are normal sequelae and that she only needs to rest more, with no need for further follow-up or medication.

I would like to ask Dr.
Zhang, is it true that no follow-up is necessary for this type of traumatic intracranial hemorrhage? Can the blood clots completely reabsorb on their own? Is there no need for medication? (Chi Mei Hospital prescribed neuro-stabilizers and medications to promote circulation and prevent seizures upon discharge.) Additionally, is there a possibility of re-bleeding with this type of traumatic intracranial hemorrhage? What preventive measures should be taken?

yunyun, 30~39 year old female. Ask Date: 2022/06/15

Dr. Zhang Junwei reply Neurosurgery

Blood clots will be absorbed, and the chance of rebleeding is low; prevention is not possible.

Reply Date: 2022/06/15

More Info

Post-traumatic intracranial hemorrhage (PTIH) is a serious condition that can arise from head injuries, such as the one your mother experienced. Given the complexity of her injuries, which include skull fractures, subarachnoid hemorrhage, subdural hematoma, and contusions, it is crucial to understand the implications for her recovery and the need for follow-up care.

Firstly, it is important to note that the symptoms your mother is experiencing, such as occasional memory lapses and feelings of unreality, can be common after a traumatic brain injury (TBI). These symptoms may be indicative of post-concussion syndrome or other cognitive impairments that can occur following such injuries. While the medical team at Chi Mei Hospital assessed her condition and determined that surgery was not necessary, the absence of surgical intervention does not eliminate the need for careful monitoring and follow-up.

Regarding follow-up care, it is generally advisable for patients with significant head injuries to have ongoing assessments, especially in the weeks and months following the incident. This is because symptoms can evolve, and complications such as rebleeding or the development of new neurological deficits can occur. Even if the initial imaging studies do not show significant issues, changes can develop over time. Therefore, it would be prudent to seek a second opinion or request a follow-up with a neurologist or neurosurgeon who specializes in TBI.

As for the absorption of blood clots, it is true that many hematomas can resolve on their own over time. The body has mechanisms to reabsorb blood and clear out the debris from the injury. However, the timeline for this process can vary significantly between individuals, and some clots may take longer to resolve than others. Regular imaging, such as CT or MRI scans, may be necessary to monitor the status of any residual hematomas.

In terms of medication, while your mother may not require ongoing treatment, the initial prescriptions for neurostabilizers and medications to prevent seizures were likely precautionary. It is essential to follow the advice of her healthcare providers regarding medication use. If she continues to experience symptoms such as headaches or dizziness, discussing these with her doctor is crucial, as they may warrant further intervention.

Regarding the risk of rebleeding, while the likelihood decreases over time, it is not entirely eliminated. Factors such as the severity of the initial injury, the presence of anticoagulant medications, and the overall health of the patient can influence this risk. Preventive measures include avoiding activities that could lead to another head injury, managing blood pressure, and adhering to any prescribed medication regimens.

In summary, while your mother's initial assessment may not indicate the need for further intervention, it is essential to remain vigilant and proactive about her recovery. Regular follow-ups with a healthcare provider specializing in brain injuries, monitoring her symptoms, and being aware of any changes in her condition are critical steps in ensuring her long-term health and recovery. If you have concerns about her current treatment plan, do not hesitate to seek additional opinions or request further evaluations.

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