Head Injury
Risks and Treatment
Intracranial hemorrhage (ICH) is the leading cause of death from bleeding in all age groups. Without early recognition and treatment, death or severe neurologic impairment can occur. ICH may be spontaneous, without history of injury. Early neurologic symptoms may not be evident due to the slow, oozing nature of hemophilia bleeding.
All significant head trauma, with or without hematoma, must be treated promptly with the major dose of factor replacement before any diagnostic tests.
Diagnostic imaging
Obtain an emergency CT scan to rule out ICH after the major factor dose has been given. Notify the patient's hematologist or hemophilia treatment center of the ED admission and the diagnostic findings.
Possible admission
The patient should be admitted to the hospital for observation if he suffered a severe blow to the head or if he exhibits any neurologic symptoms such as headache with increased severity, irritability, vomiting, seizures, vision problems, focal neurologic deficits, stiff neck, or changes in level of consciousness. Patients with a past history of ICH are at increased risk of repeated head bleeds.
Discharge instructions
If the patient is discharged home, instruct the family to monitor the patient for signs and symptoms of neurologic deterioration and report any abnormalities to the hematologist. Consult the hematologist for follow-up factor replacement doses if the patient is discharged home from the emergency department. Give head injury instructions for a two week period instead of the usual instructions for a 24 - 48 hour period.