Intracranial Haemorrhages

Sanjaya AdikariDepartment of Anatomy

Intracranial Haemorrhages

Intracerebral Extracerebral

Extradural (epidural) haemorrhage

Arterial bleeding

Bleeding from middle meningeal artery

Following a hard blow to the head

Blood collects between dura mata and skull

Extradural haematoma is formed

Haematoma biconvex in shape

Brain compression and death if not evacuated

Middle meningeal artery

Subdural haematoma

Venous bleeding

Bleeding due to tearing of cerebral veins as they enter superior sagittal sinus

Following a blow to the head that jerks the brain inside the cranial cavity

Incident is usually long before and forgotten

Blood collects between dura mata and arachnoid mater

Subdural haematoma is sickle shaped

Subarachnoid haemorrhage

Usually arterial bleeding

Bleeding from internal carotid and circle of willis arteries

Due to arterial aneurysms (ruptured due to high blood pressure)

Blood collects in the subarachnoid space

CSF gets mixed with blood----Xanthochromasia

Severe headache and neck stiffness due to meningeal irritation

Sequence of events following head injury and raised intracranial pressure

Initial concussion

Lucid interval

Drowsiness

Pupils initially constrict then dilated and fixed

Pulse initially may increase then reduce

BP increases with reducing pulse (cushing reflex)

Should monitor BP, pulse, respiration and pupils

Cerebral herniation through tentorium cerebelli

Uncus

Question

• An individual received a fracture of the left temporal bone due to an accident. Subsequently, he developed extradural haemorrhage. Few hours later, he became drowsy and confused. An examination of his eyes showed a dilated left pupil that was non-reactive to light. His BP was high and pulse rate was reduced.

• 1. Name the vessel involved in producing bleeding in this case.

• 2. Explain the reasons for the following observations

2.1. Dilated, non-reactive pupil of left eye2.2. Reduced pulse rate