Intracranial Hemorrhage: Symptoms, Risks, and Recovery

Intracranial hemorrhage

Hello Doctor,
After having two upper molars extracted two years ago, I started feeling unwell.
Later, at work, I was struck on the head by a heavy iron pipe that fell from above.

1.
I am uncertain if I have hypertension; my company health check-ups have been normal, and I occasionally measure my blood pressure at home, which is also normal.
However, whenever I measure it at the hospital, it is generally above 150.
On the day of the tooth extraction, I did not pay particular attention to my blood pressure, and the clinic did not measure it.
In the case of uncertainty regarding hypertension, is there a possibility of intracranial hemorrhage during the tooth extraction? If that were the case, would I have fainted at the time? After all, I started feeling unwell after the extraction, and over a year later, my brain discomfort has not improved, leading me to consider extreme possibilities.

2.
A few days after the extraction, I was not aware of being hit by the iron pipe due to my brain discomfort.
I went for an X-ray, which showed no skull fracture.
Three months later, I had a CT scan, and the doctor said there was no issue with the skull and no intracranial hemorrhage.
Doctor, if there had been a previous intracranial hemorrhage that later absorbed, would it be visible on a CT scan? If there had been a skull fracture that healed, could a CT scan show evidence of past injury? I have been feeling unwell for a long time without any clear diagnosis, and I was previously a very healthy person.
This has greatly affected my quality of life.
What can I do to help myself? Thank you for your response.

A Lun, 30~39 year old female. Ask Date: 2022/09/21

Dr. Jiang Junyi reply Neurology

Hello Mr.
Allen,
You mentioned, "If there was a brain hemorrhage that was absorbed by itself, can it be seen on a CT scan? If the skull had previously fractured and healed, can a CT scan show that there was a prior injury?" Typically, in cases of severe brain injury, since brain cells do not regenerate, traces of the hemorrhage can be observed.
For small hemorrhages less than 5ml, it may be necessary to rely on MRI T2* imaging to detect iron deposition.
Regarding your concern about "persistent discomfort in the head with no identifiable cause, despite being a previously healthy individual," it may be worth considering issues related to the cervical spine.
The paravertebral fascia has small muscles that connect to the head, and the larger superficial muscles in the shoulder and neck are engaged during significant movements.
This could lead to a situation where occipital headaches are more pronounced than shoulder and neck discomfort.
For nerve repair, it is advisable to supplement with B vitamins and to avoid exposure to secondhand smoke.
I recommend consulting a neurologist to discuss further examinations and treatment options.
Thank you for your inquiry, and feel free to reach out for any related questions.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares for you.

Reply Date: 2022/09/21

More Info

Understanding intracranial hemorrhage (ICH) is crucial, especially for individuals who have experienced head trauma or dental procedures that may lead to complications. In your case, there are several factors to consider regarding the potential for ICH following dental surgery and subsequent head trauma.

1. Risk Factors for Intracranial Hemorrhage:
While you mentioned that your blood pressure readings at home are normal, it’s important to note that stress and anxiety, particularly in a hospital setting, can elevate blood pressure readings. If you have undiagnosed hypertension, this could increase your risk for ICH, especially during or after a surgical procedure like tooth extraction. Although it is uncommon for a dental procedure to directly cause ICH, the stress of the procedure, combined with any underlying vascular issues, could potentially lead to complications. If you had experienced a significant ICH at the time of the extraction, symptoms such as severe headache, confusion, or loss of consciousness would likely have manifested immediately.

2. Symptoms and Diagnosis:
After your dental procedure, if you began to experience persistent discomfort or neurological symptoms, it would be prudent to seek medical evaluation. The fact that you were hit on the head by a heavy object adds another layer of risk. Although initial X-rays showed no fractures, CT scans are more sensitive for detecting ICH. If a hemorrhage occurred, it might not have been visible immediately, especially if it was small or if the body began to reabsorb the blood quickly.
3. Follow-Up Imaging:
If you had a previous ICH that resolved, a follow-up CT scan might not show any residual signs of the hemorrhage, as the body can effectively clear out the blood over time. However, any structural changes, such as scarring or alterations in brain tissue, might not be visible unless significant damage occurred. If your symptoms persist, it is essential to communicate this to your healthcare provider, as further imaging or evaluation may be warranted.

4. Long-Term Effects and Recovery:
Persistent symptoms such as headaches, dizziness, or cognitive changes can significantly impact your quality of life. It is crucial to address these symptoms with a healthcare professional who can conduct a thorough evaluation. This may include neurological assessments, additional imaging, or referrals to specialists such as neurologists or rehabilitation experts.
5. Self-Advocacy and Next Steps:
Given your ongoing discomfort and the impact on your daily life, consider advocating for yourself by requesting a comprehensive evaluation. This could involve a detailed neurological examination, a review of your medical history, and possibly further imaging studies to rule out any underlying issues that may not have been previously identified.
6. Lifestyle and Management:
In the meantime, managing stress, maintaining a healthy lifestyle, and monitoring your blood pressure can be beneficial. Engaging in regular physical activity, practicing relaxation techniques, and ensuring adequate sleep can also support overall brain health.

In conclusion, while the risk of ICH from a dental procedure is relatively low, the combination of factors in your case warrants careful consideration and follow-up. Persistent symptoms should not be ignored, and seeking further evaluation is essential for your health and peace of mind.

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