Hello everyone, today's topic is intracranial hemorrhage. I am going to discuss why epidural hemorrhage looks like a biconvex disc on CT, what is the lucid interval, what are the types of intraventricular hemorrhage. So stay tuned for the next 5 minutes.
Welcome back. Intracranial hemorrhage basically means hemorrhage within the cranium or skull. It is actually a broad term because hemorrhage can occur in different regions within the skull. So broadly, we can divide it into extra axial hemorrhage and intra axial hemorrhage.
Extra axial hemorrhage means bleeding occurs within the skull but outside the brain tissue and intracranial hemorrhage means bleeding occurs within the brain tissue. Now extracranial hemorrhage can be subdivided into epidural, subdural and subarachnoid hemorrhage and intracranial hemorrhage can be subdivided into intracerebral hemorrhage and intraventricular hemorrhage. This video is an overview of different types of intracranial hemorrhage. Later we will discuss in detail.
Let's see first what is epidural hemorrhage. Here I am drawing a coronal section of brain. This yellow portion is a skull and the brown portion is the brain tissue or brain parenchyma.
Now epi means evolve. So When the bleeding occurs just above the dura mater it is called epidural hemorrhage. So bleeding occupies the space between the skull bone and dura mater. Epidural hemorrhage mostly occurs due to rupture of medial meningeal artery which is the branch of maxillary artery.
On CT it appears to be a typical biconvex disc because dura mater tightly attached with the sutural ligament. so blood cannot go beyond this region and accumulates within a confined area. So on CT it looks like a typical biconvex lens.
Gradually increasing pressure within the cranial vault can cause herniation of brain tissue and even harden up palsy. Another important thing I would like to mention is lucid interval which is typically seen in epidural hemorrhage. Initially the patient is knocked out by the force of trauma but body can compensate if the bleeding is within a certain limit.
So for a short period of time patient becomes relatively lucid or comfortable but when the hematoma expand beyond the compensatory limit and starts compressing the brain tissue patient again becomes unconscious. This time interval between two unconsciousness is called lucid interval. Now come to subdural hemorrhage where bleeding occurs in between the dura and arachnoid matern. Most of the time it is due to rupture of the bridging veins. On CT it appears to be crescent shaped.
It is seen mostly in elderly person, alcoholics and sometimes newborn baby. If someone forcefully or violently shaken the baby it is quite possible that the bridging vein will be ruptured. Next is sub arachnoid hemorrhage where bleeding occurs in between arachnoid and pia mater. Most of the time it is due to rupture of an aneurysm most commonly baryaneurysm.
Patient with Marfan and Ehler-Danlos syndrome has more chances to develop that type of aneurysm because of the abnormalities of collagen fibers. Sometimes patient complains of ost headache of my life so keep this in mind. Now come to the intraaxial hemorrhage.
As I have already mentioned that it is of two types intracerebral and intraventricular. When bleeding occurs within the brain tissue or any part of the cerebrum it is called intracerebral hemorrhage. It is the second most common cause of stroke as you know that the most common cause is embolus or thrombus formation due to atherosclerosis.
Most common cause for this type of hemorrhage is systemic hypertension. Bleeding typically occurs in basal ganglia and internal capsule area. Now lastly intraventricular hemorrhage where bleeding occurs within or just adjacent to ventricle.
It can be divided into four types. Grade 1 is when bleeding occurs near the ventricle. Grade 2 is when bleeding occurs within the ventricle and grade 3 is when ventricle is enlarged due to pressure within and grade 4 is enlarged ventricle with blood in the brain tissue.
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