Intracerebral hematomas are a collection of free blood within the substance of the brain. It can arise spontaneously from either a ruptured atherosclerotic vessel or from an aneurysm or arteriovenous malformation. It can also be induced by head trauma in which case it is referred to as traumatic.
The size of the blood clot and its location determine the degree of a neurological deficit and the treatment principles are the same as previously discussed in dealing with a mass lesion. In some instances, the pressure volume curve is relatively flat and the intracranial pressure does not reach critical levels.
In such circumstances, the blood clot will be liquefied and eventually dissolved by brain cells and no surgery is required. In other instances where the ICP reaches levels critical to develop vector of forces, rapid surgical evaluation is required prior to development of herniation. In addition, in patients in whom the blood clot resulted from a ruptured aneurysm require its clipping and the AVMs need to be resected or otherwise treated.
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