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Intracranial Hemorrhage

09/11/2022 Conditions

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Intracranial hemorrhage is bleeding inside the skull (cranium). It occurs when a blood vessel in or near the brain ruptures or leaks, bleeding into the brain or surrounding area.

When the blood vessel ruptures, normal blood flow to part of the developing brain is disrupted, depriving those brain cells of oxygen (known as a stroke).

In addition, as the blood that spills from the ruptured blood vessel accumulates or pools, it can compress the brain, damaging brain cells. The areas of the body controlled by the damaged brain cells will be unable to work properly.

While outcomes vary in each child, an intercranial hemorrhage can result in significant neurologic impairment in the child and in some cases cause fetal or newborn death.

How does intracranial hemorrhage affect my baby?

The impact of intracranial hemorrhage depends on the location and extent of the bleeding (pressure on the brain), the severity of the bleed, and the gestational age of the baby.

Complications may include:

  • Hydrocephalus
  • Postnatal seizure disorders (epilepsy)
  • Intellectual disability 
  • Cerebral palsy
  • Impaired motor skills
  • Vision and hearing problems
  • Difficulties with speech and language
  • Learning disabilities
  • Fetal or neonatal death

Cause

The cause of intracranial hemorrhage is typically unknown.

Maternal and fetal risk factors include:

Maternal

  • Infection during pregnancy
  • Trauma
  • Seizure disorders
  • Blood clotting disorders
  • Certain medications
  • Illegal drug use
  • Placental and umbilical cord abnormalities
  • Genetic abnormalities

Fetus

  • Fetal thrombocytopenia (fetal and neonatal alloimmune thrombocytopenia, FNAIT)
  • Congenital factor X and factor V deficiencies
  • Fetal vascular malformations

Types of Intracranial Hemorrhage

There are several types of intracranial hemorrhage, based on the location of the bleeding in the skull. The most common type is intraventricular hemorrhage (IVH), where the bleeding occurs inside or around the ventricles, the spaces or cavities in the brain containing cerebrospinal fluid.

Intraventricular hemorrhages are graded 1 through 4 based on the amount of bleeding, with 4 being the most severe, posing a high risk of neurological problems in the newborn. Fetal imaging may be used to grade the condition and predict the condition of the newborn at birth.

Diagnosis

During pregnancy

Intracranial hemorrhages may be diagnosed before birth during a routine prenatal ultrasound. An ultrasound may detect conditions such as ventriculomegaly (enlargement of the fluid-fill spaces in the brain known as ventricles), hydrocephalus (fluid build-up that puts pressure on the fetal brain) or other abnormal findings that when further evaluated with an MRI lead to a diagnosis of intracranial hemorrhage.

After birth

In other cases, intracranial hemorrhage may not be diagnosed until after birth. Sometimes symptoms may not appear until months or even years later.

The most common signs and symptoms in a newborn include:

  • Seizures
  • Extreme sleepiness
  • Feeding difficulties
  • Apnea (breathing pauses)
  • Anemia

Additional signs that may be evident as the child grows older include:

  • Weakness or paralysis on one side of the body
  • Difficulty moving
  • Poor coordination
  • Delays in speech or other signs of developmental delay
  • Muscle tone abnormalities

Diagnostic testing to confirm the condition after birth may include ultrasound, MRI, and/or computed tomography (CT).

Specialized Evaluation and Care

If intracranial hemorrhage is diagnosed or suspected during pregnancy, you may be referred to a fetal center for further evaluation and specialized care, ensuring proper treatment planning.

At Texas Children’s Fetal Center, we arrange for a detailed assessment by a team of specialists experienced in diagnosing and treating intracranial hemorrhage, including maternal-fetal medicine physicians, fetal imaging experts, pediatric neurosurgeons and neurologists, genetic counselors and neonatologists.

You will undergo additional testing to help us gain critical information, including:  

Our specialists will then meet with you about your results, answer any questions your family has, and discuss your baby’s prognosis and possible treatment needs at birth. A diagnosis during pregnancy enables your family and your healthcare team to plan ahead for the specialized expertise your baby will need after birth, for timely treatment.

Pregnancy and Delivery

You and your baby will be closely monitored throughout pregnancy with more frequent ultrasounds to assess fetal growth and watch for signs of complications, such as fetal heart rate changes and severe fetal anemia.

We recommend delivery at a hospital with the expertise and resources required to care for newborns with intracranial hemorrhage, including the highest level neonatal intensive care unit (NICU), if needed.

Treatment After Birth

Treatment after birth is focused on managing the child’s symptoms and maximizing their ability to function, such as:

  • Medications to control seizures
  • Physical and occupational therapy
  • Speech therapy
  • Treatment for vision or hearing impairments
  • Behavioral therapy

In addition to a newborn evaluation by a pediatric neurologist experienced in fetal intracranial hemorrhage, regular follow-up visits are recommended to monitor the child for signs of developmental problems or disabilities.

Postnatal Care Team

Depending on your baby’s condition, his or her postnatal care team may include:

A unique and distinct advantage for mothers delivering at Texas Children’s Pavilion for Women is our location inside one of the top children’s hospitals in the nation, for seamless access to the critical care services and specialists your child may need after birth. Texas Children’s Hospital is ranked #3 in the nation for pediatric neurology and neurosurgery care by U.S. News & World Report.

For babies with intracranial hemorrhage, this means no transfers during critical postnatal periods. It also means the pediatric specialists responsible for treating your child have been an integral part of their care team since before birth.

Why Texas Children’s Fetal Center?

  • A single location for expert maternal, fetal and pediatric care. At Texas Children’s Hospital, you and your baby receive the specialized care required for the diagnosis and treatment of intracranial hemorrhage all in one location, for highly coordinated care and treatment planning, including immediate access to our level IV NICU, the highest level of care available for premature and critically ill newborns.
  • A skilled, experienced team with proven outcomes. We have a dedicated team of maternal-fetal medicine specialists, fetal imaging experts, pediatric neurosurgeons and neurologists, neonatologists and others who work in concert to care for you and your baby every step of the way, using proven protocols we’ve developed over the years. With their combined expertise and unified approach, this team offers the best possible care for babies with intracranial hemorrhage.
  • We care for your child’s needs at every stage of life. Our comprehensive approach starts with your first prenatal visit and continues through delivery, postnatal care, and childhood, thanks to one of the nation’s leading teams of fetal and pediatrics specialists for the care and treatment of the rare fetal brain conditions.

Additional Resources

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For more information or to schedule an appointment,

call Texas Children’s Fetal Center at 832-822-2229 or 1-877-FetalRx (338-2579) toll-free.

Our phones are answered 24/7. Immediate appointments are often available.