Intracranial Hemorrhage

Intracranial Hemorrhage is a broad term for bleeding that occurs within the skull. It is categorized into two main types:

1. Extra-axial Hemorrhage - Bleeding outside the brain tissue.
2. Intra-axial Hemorrhage - Bleeding within the brain tissue.

Types of Extra-axial Hemorrhage

1. Epidural Hemorrhage

• Occurs between the skull and the dura mater (Dural membrane).
• Often results from head trauma.
  • 70-95% cases present with skull fractures.
  • Common causes: motor vehicle accidents, falls, assaults.
• Source of bleeding: arterial (e.g., middle meningeal artery).
• Clinical manifestations:
  • Altered state of consciousness
  • Headache
  • Vomiting
  • Confusion
  • Seizures
  • Aphasia

2. Subdural Hemorrhage

• Occurs between the dura mater and the arachnoid membrane.
• Similar causes as epidural hemorrhage.
• Source of bleeding: tearing of bridging veins.
• Clinical manifestations:
  • Coma in 50% of cases
  • Lucid interval followed by progressive neurological decline

3. Subarachnoid Hemorrhage

• Occurs within the subarachnoid space.
• Commonly caused by rupture of a saccular aneurysm.
  • Aneurysm: sack-like bulge on an artery.
• Non-aneurysmal causes exist but not discussed.
• Clinical manifestations:
  • Thunderclap headache
  • Loss of consciousness
  • Seizures
  • Nausea and vomiting
  • Meningismus (triad of symptoms: stiff neck, photophobia, and more)

Types of Intra-axial Hemorrhage

1. Intracerebral Hemorrhage

• Occurs within the brain tissue.
• Subtypes include:
  • Lobar Hemorrhage (specific lobes)
  • Thalamic Hemorrhage
  • Pontine Hemorrhage
  • Cerebellar Hemorrhage
• Second most common cause of stroke.
• Causes include:
  • Hypertension
  • Embolism
  • Brain tumors
  • Bleeding disorders
  • Drug use
• Clinical manifestations depend on the affected brain region:
  • Headache
  • Nausea and vomiting
  • Decreased level of consciousness
  • Neurological signs specific to the affected area (e.g., issues with respiration or heart rate if occurring in the pons or medulla)

2. Intraventricular Hemorrhage

• Bleeding within the ventricles of the brain.
• Often secondary to other hemorrhages (e.g., intracerebral or subarachnoid hemorrhage).

Recap

• Intracranial hemorrhage includes both bleeding outside and within the brain tissue.
• Important examples include epidural, subdural, and subarachnoid hemorrhage (extra-axial), as well as intracerebral and intraventricular hemorrhage (intra-axial).