Intracranial hemorrhagesSiti hazaimah

Intracranial hemorrhages

Classification in function of location:

- Epidural- Subdural- Subarachnoid- Intracerebral/ Intraparenchymal

Epidural Hematoma- Etiology: trauma → skull fracture

(temporo-parietal bone) → tear of Middle Meningeal Artery.

Epidural Hematoma

- Epidemiology: 0.5% head injuries young adult, male to female 4:1

- Presentation: 1. Initial LOC 2. “Lucid interval” for several hours3. Obtundation, CL Hemiparesis, IL

pupil dilation

Epidural Hematoma- Evaluation: CT brain non-contrast

84% high density biconvex (lenticular)

40% have no identifiable skull fractures.- Prognosis: good with early intervention

Epidural Hematoma- Treatment: 1. Medical management if <1cm and

no neuro signs

2. Surgery (craniotomy): any symptomatic EDH.- Clot removal to ↓ICP- Hemostasis- Prevent

re-accumulation

Subdural Hematoma- Etiology: violent head mvt. → accel-

deccel of brain in cranium → tear of Bridging veins.

Subdural Hematoma

- Epidemiology: 30% head injuries. ↑ risk in elderly and infants

- Presentation: 1. Headache, confusion, lethargy2. +/- focal signs3. Slowly progressive neurological

decompensation.

Subdural Hematoma- Evaluation: CT brain non-contrast

Crescentic mass-A =Hyderdense: 1-3d-Sub-A=Isodense: 4d-3wk-C =Hypodense: 3wk-4mo

- Prognosis: Mortality 50-90%; due to underlying brain injury.

Subdural Hematoma

- Treatment: 1. Rapid surgical evacuation with

craniotomy for symptomatic patients.

2. Subdural drain in neurologically stable patient.

3. Observation if less than <1cm

Subarachnoid Hemorrhage- Etiology: cerebral artery injury

(aneurysm/ AVM rupture, trauma) → blood leakage in SA space → meningeal irritation.

Subarachnoid Hemorrhage

- Epidemiology: most common head injury. Aneurysm peak 55-60yrs.

- Presentation: 1. “The worst HA of my life”2. Meningismus3. Focal neurological deficits4. Obtundation to coma

Subarachnoid Hemorrhage

Evaluation: CT brain non-contrast → LP → Angiogram

Blood in sulci and cisternsXanthochromia

- Prognosis: Mortality 32-67%.

Subarachnoid Hemorrhage

- Treatment: 1. Surgical intervention directed at

stopping the bleeding and lowering ICP.

2. Medical management of complication (vasospasm, stoke)

Intraparenchymal Hemorrhage- Etiology: Intracerebral artery injury

(aneurysm/ AVM rupture, arteriopathy, HTN, trauma), hemorrhagic stroke.

Intraparenchymal Hemorrhage

- Epidemiology: men, >55yo, blacks, h/o HTN, h/o CVA, alcohol consumption, smoking, drug use.

- Presentation: greatly varies in function of the location. Onset during activity.

Intraparenchymal Hemorrhage- Evaluation: Brain CT /MRI/Angio

Hemorrhage:-lobar-Internal capsule-Ganglio-thalamic-Pontine

- Prognosis: Highly variable.

Intraparenchymal Hemorrhage

- Treatment: 1. Medical management (BP control,

hemostasis). 2. Surgical intervention is

controversial.