Blood Clot in the Brain

A blood clot in the brain, called a haematoma, is a collection of blood between the skull and the brain or its coverings. An extradural haematoma forms between the skull and the outer covering of the brain, usually after a head injury. A subdural haematoma forms under this covering and can appear within hours of an injury (acute) or slowly over weeks (chronic).

This is different from a clot that blocks a blood vessel and causes a stroke, which is treated differently.

Symptoms

• Headache that keeps getting worse
• Vomiting
• Drowsiness, confusion or unconsciousness
• Weakness or numbness on one side of the body
• Difficulty in speaking, walking or keeping balance
• Fits (seizures)
• In chronic subdural haematoma, slow changes over weeks such as forgetfulness, change in behaviour, reduced activity or frequent falls, which may be mistaken for old age or a stroke

With an extradural haematoma, a person may wake up and seem normal for a while after the injury and then quickly become drowsy.

Causes

• Head injury from road accidents, falls or assault
• Minor falls or bumps in elderly people, sometimes so small that the fall is not remembered
• Blood-thinning medicines or bleeding disorders
• Long-term heavy alcohol use

Diagnosis

A CT scan of the head is the main test. It shows the size and position of the clot and how much it is pressing on the brain. An MRI is sometimes advised. Blood tests check how well the blood clots, especially in people taking blood-thinning medicines.

Treatment

Treatment depends on the size of the clot, how much pressure it causes and the patient's condition. Not every clot needs surgery. A small clot in a patient who is alert and stable may be watched closely with repeat CT scans. Blood-thinning medicines may need to be stopped or adjusted, but only on a doctor's advice. Some small chronic clots slowly shrink on their own over time.

Surgery is advised when the clot is large, pressing on the brain or causing symptoms:

Extradural and acute subdural haematoma: a large clot is an emergency. A craniotomy is done to open a part of the skull, remove the clot and stop the bleeding. If the brain is very swollen, the bone piece may be kept out for some time and replaced later.

Chronic subdural haematoma: the old, liquid blood is usually drained through one or two small holes in the skull (burr hole surgery). This is a smaller operation, and a thin drain is often left for a short time. Endoscopic techniques may help in selected cases. A chronic clot can sometimes come back, so follow-up scans are important.

When to Seek Urgent Care

• Increasing drowsiness or difficulty waking up after a head injury
• Severe or worsening headache with vomiting
• New weakness, numbness or difficulty in speaking
• Fits (seizures)
• One pupil larger than the other
• Sudden confusion in an elderly person, especially after a fall or while taking blood-thinning medicines

If you notice any of these signs, go to the nearest emergency immediately.

If you or a family member has been told there is a blood clot in the brain, you can consult Dr. Prashant Sharma at Keshav Super Speciality Hospital, Meerut, for a careful review of the scans and treatment options.

Related Conditions

• Brain Haemorrhage
• Brain Stroke
• Epilepsy (Fits / Seizures)
• Brain Tumour
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