Intracranial Hemorrhage Lecture

Overview

• Intracranial Hemorrhage: Refers to bleeding within the cranium or skull.
• Broad Categories:
  • Extra Axial Hemorrhage: Bleeding within the skull but outside the brain tissue.
  • Intra Axial Hemorrhage: Bleeding within the brain tissue.

Types of Hemorrhage

Extra Axial Hemorrhage

• Types:
  • Epidural Hemorrhage
  • Subdural Hemorrhage
  • Subarachnoid Hemorrhage

Epidural Hemorrhage

• Location: Bleeding above the dura mater between the skull bone and dura mater.
• Cause: Typically due to rupture of the medial meningeal artery (branch of maxillary artery).
• CT Appearance: Biconvex disc shape due to dura mater attachment with sutural ligament.
• Effects: Can cause increasing pressure, brain herniation, or palsy.
• Lucid Interval: Temporary period of consciousness after initial trauma before unconsciousness returns.

Subdural Hemorrhage

• Location: Bleeding between the dura mater and arachnoid mater.
• Cause: Often due to rupture of bridging veins.
• CT Appearance: Crescent-shaped.
• At-risk Groups: Elderly, alcoholics, newborns (e.g., shaken baby syndrome).

Subarachnoid Hemorrhage

• Location: Bleeding between arachnoid and pia mater.
• Cause: Often due to rupture of an aneurysm, commonly berry aneurysms.
• Associated Conditions: Marfan syndrome, Ehlers-Danlos syndrome.
• Symptom: Sudden severe headache often described as "worst headache of my life."

Intra Axial Hemorrhage

• Types:
  • Intracerebral Hemorrhage
  • Intraventricular Hemorrhage

Intracerebral Hemorrhage

• Location: Bleeding within brain tissue or cerebrum.
• Cause: Commonly due to systemic hypertension.
• Common Sites: Basal ganglia, internal capsule.
• Relation to Stroke: Second most common cause of stroke after embolus or thrombus.

Intraventricular Hemorrhage

• Location: Bleeding within or adjacent to ventricles.
• Grades:
  • Grade 1: Bleeding near the ventricle.
  • Grade 2: Bleeding within the ventricle.
  • Grade 3: Enlarged ventricle due to pressure.
  • Grade 4: Enlarged ventricle with bleeding into brain tissue.

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