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A 44-year-old man presented to the ED after craniocerebral trauma from a tractor fall, with impaired consciousness (GCS 8), seizures, and hemodynamic instability. CT showed a large left frontal hematoma with intraventricular and subarachnoid hemorrhage. Conservative ICU management prioritized airway protection, ICP control, hemodynamic stabilization, seizure prophylaxis, and infection prevention. Clinical recovery, progressive hematoma resorption on serial imaging, and discharge after 17 days supported a favorable outcome in selected patients.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/acute-traumatic-intracerebral-hematoma-to-operate-or-not-to-operate-case-report/422997/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/acute-traumatic-intracerebral-hematoma-to-operate-or-not-to-operate-case-report/422997.png","ImageObject",300,407,{"name":92,"@type":93},"dawugda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is acute traumatic intracerebral hematoma (TICH) and why is it serious?","Question",{"text":113,"@type":114},"TICH is bleeding into brain tissue caused by traumatic disruption of blood vessels. It is associated with high morbidity and mortality due to mass effect, rising intracranial pressure, and secondary injury mechanisms.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What treatment approach was used for the reported patient?",{"text":118,"@type":114},"The neurosurgical team chose conservative ICU treatment, focusing on airway protection, intracranial pressure control, hemodynamic stabilization, seizure prophylaxis, and infection prevention.",{"name":120,"@type":111,"acceptedAnswer":121},"What did imaging and clinical progress show during follow-up?",{"text":122,"@type":114},"Serial imaging demonstrated progressive resorption of the hematoma. The patient showed gradual improvement, with restoration of consciousness and regression of neurological deficits, leading to discharge after 17 days.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},422997,1790852329,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":46,"preview_page_count":4},3985747870947,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Review began 10/22/2025  \nReview ended 12/02/2025  \nPublished 12/04/2025  \n© Copyright 2025  \nGrabarczyk et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98442  \nOpen Access Case Report  \nAcute Traumatic Intracerebral Hematoma: To Operate or Not to Operate?  \nLukasz Grabarczyk 1 , Aleksandra Grosz 2 , Grazyna Waska 3 , Kamil Sobolewski 4, Pawel Radkowski 5  \n1. Department of Neurological Surgery, Alarm Clock Clinic, Coma Recovery and Neurorehabilitation Center, Warsaw, POL 2. Faculty of Medicine, Medical University of Łódź, Łódź, POL 3. Department of Internal Medicine, Specialist Hospital No. 1 in Bytom, Bytom, POL 4. Department of Anesthesiology and Intensive Care, Municipal Polyclinical Hospital, Olsztyn, POL 5. Department of Anesthesiology and Intensive Care, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, POL  \nCorresponding author: Grazyna Waska, [grazynawaska@gmail.com](grazynawaska@gmail.com)  \nAbstract  \nAcute traumatic intracerebral hematoma (TICH) is a severe complication of head injury, often associated with high morbidity and mortality. We report the case of a 44-year-old man admitted to the ED after acraniocerebral trauma caused by a fall from a tractor. On admission, he presented with impaired consciousness, scoring 8 on the Glasgow Coma Scale, with eye opening to pain (E2), incomprehensible verbal responses (V2), and withdrawal to painful stimuli (M4) . Seizures and hemodynamic instability were also noted. CT revealed a large left frontal lobe hematoma with intraventricular and subarachnoid hemorrhage. In cooperation with the neurosurgical team, a decision was made to initiate conservative treatment in the ICU, focusing on airway protection, intracranial pressure control, hemodynamic stabilization, seizure prophylaxis, and infection prevention. During the following days, gradual clinical improvement was observed, with restoration of consciousness and regression of neurological deficits. Serial imaging demonstrated progressive resorption of the hematoma. The patient was discharged after 17 days in good general condition and transferred for rehabilitation, with only mild residual right lower limb weakness and minor cognitive impairment. This case highlights that, in selected patients, conservative management ofTICH may lead to a favorable outcome despite extensive hemorrhage.  \nCategories: Neurology, Trauma, Anesthesiology  \nKeywords: conservative medical management, intracranial hemorrhage, medical intensive care unit (micu), severe combined traumatic brain injury, traumatic intracerebral hematoma  \nIntroduction  \nAcute traumatic intracerebral hematoma (TICH) is most often caused by a traumatic brain injury. The term describes bleeding into the brain tissue as a result of disruption of the blood vessel endothelium [1,2] . In the initial phase of injury, rupture of a blood vessel leads to the formation of a hematoma, which has a mass  \neffect, compressing the brain parenchyma and disrupting its structure. This leads to the release of substances that damage the blood-brain barrier, causing brain swelling and apoptosis of neurons and glial cells [3] . Survival and recovery after intracerebral hemorrhage (ICH) depend on the location and size of the hematoma, its mass effect, and the increase in intracranial pressure. In addition, prognosis is influenced by secondary injury mechanisms, such as cerebral edema, inflammatory responses, and complications resulting from prolonged neurological dysfunction [4] . The clinical picture of these hematomas is highly variable and can include sudden disturbances of consciousness, focal neurological deficits such as hemiparesis, aphasia, and ataxia, as well as symptoms of intracranial hypertension, including headache, vomiting, and pa","cbCaiebAgWjcn8r8","https://ap.wps.com/l/cbCaiebAgWjcn8r8","pdf",3465533,"English","# Abstract\n# Introduction\n# Case Presentation\n# How to cite this article\n# Figure 1","[{\"question\":\"What is acute traumatic intracerebral hematoma (TICH) and why is it serious?\",\"answer\":\"TICH is bleeding into brain tissue caused by traumatic disruption of blood vessels. It is associated with high morbidity and mortality due to mass effect, rising intracranial pressure, and secondary injury mechanisms.\"},{\"question\":\"What treatment approach was used for the reported patient?\",\"answer\":\"The neurosurgical team chose conservative ICU treatment, focusing on airway protection, intracranial pressure control, hemodynamic stabilization, seizure prophylaxis, and infection prevention.\"},{\"question\":\"What did imaging and clinical progress show during follow-up?\",\"answer\":\"Serial imaging demonstrated progressive resorption of the hematoma. The patient showed gradual improvement, with restoration of consciousness and regression of neurological deficits, leading to discharge after 17 days.\"}]","Acute Traumatic Intracerebral Hematoma - To Operate or Not to Operate - Case Report | PDF",1790629661]