Difference between revisions of "Intracranial hematomas"
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'''Intracranial hematomas''', also intracranial hemorrhage''', are bad stuff that keep neurosurgeons busy. They are usually diagnosed by imaging (CT head). | '''Intracranial hematomas''', also '''intracranial hemorrhage''', are bad stuff that keep neurosurgeons busy. They are usually diagnosed by imaging (CT head). | ||
Not much bleeding is needed to cause death. In a person without atrophy (to provide space for the blood) ~75 ml is considered enough if it is acute.<ref>McAuliffe. 15 October 2010.</ref> | Not much bleeding is needed to cause death. In a person without atrophy (to provide space for the blood) ~75 ml is considered enough if it is acute.<ref>McAuliffe. 15 October 2010.</ref> | ||
Revision as of 03:45, 28 November 2011
Intracranial hematomas, also intracranial hemorrhage, are bad stuff that keep neurosurgeons busy. They are usually diagnosed by imaging (CT head).
Not much bleeding is needed to cause death. In a person without atrophy (to provide space for the blood) ~75 ml is considered enough if it is acute.[1]
Clinical
- Headache.
- Neck stiffness.
- Vomit without diarrhea.
- Changes in level of consciousness.
Classification
By location
- Epidural hemorrhage (extradural hemorrhage).
- Patient may have lucid interval.[2]
- Middle meningeal artery.
- Radiology: biconvex.
- Subdural hemorrhage
- Damaged bridging veins: subdural space between the dura and arachnoid mater.[3]
- Radiology: crescent shape.
- Subarachnoid hemorrhage.
- Classically caused by aneuryms:[4]
- Anterior communicating artery (ACA) - most common.
- Middle cerebral artery (MCA) - second most common.
- Classically caused by aneuryms:[4]
- Intracerebral hemorrhage.
- > 60 ml at presentation (assessed via CT scan) assoc. with > 90% 30 day mortality.[5]
By vessel type
- Arterial - common.
- Venous - rare (~3-4 cases/1,000,000 people/year[6]).
Cerebral venous thrombosis
General
- Extremely rare.
- Female > male.
- May be associated with trauma.[7]
- Presentation often mimics subarachnoid haemorrhage.[8]
- Typically involves superior sagittal sinus.[8]
Gross
- Bilateral involvement.
- Congested appearance.
Subarachnoid hematoma
- Abbreviated SAH.
- AKA subarachnoid hemorrhage.
General
- In the forensic context SAH alone is not good enough.
- One needs to determine the cause, e.g. ruptured berry aneurysm or laceration of left vertebral artery.
Traumatic SAH
- May have a characteristic mastoid contusion.
- May be associated with vascular Ehlers-Danlos syndrome.
Gross
- Blood between pia mater and arachnoid membrane.
- Typically at the base of the brain.
Note:
- Ruptured berry aneurysms are best found when the brain is fresh; it is hard to dissect away fixed blood.
Intracerebral hematoma
- AKA intraparenchymal hemorrhage, AKA intracerebral hemorrhage.
General
Causes:[11]
- Hypertension.
- Cerebral amyloid angiopathy.
- Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).[12]
Gross
- Blood within the parenchyma of the brain.
Microscopic
- +/-Hemosiderin-laden macrophages.
Subdural hematoma
- AKA subdural hemorrhage.
- Abbreviated SDH.
General
Where/what:
- Bridging veins in subdural space between the dura and arachnoid mater - injured.[3]
Why?
- +/-Trauma.
- Elderly, esp. those with cerebral atrophy.[13]
Gross
- Blood in the subdural potential space.
- Crescentic shape.
Microscopic
Features:
- Blood in subdural (potential) space.
Cerebellar white mater predominant petechial hemorrhage
- AKA brain purpura.
- Etiology: fat embolism syndrome secondary to trauma.
- Image: FE (med.utah.edu).
See also
References
- ↑ McAuliffe. 15 October 2010.
- ↑ Erşahin Y, Mutluer S, Güzelbag E (April 1993). "Extradural hematoma: analysis of 146 cases". Childs Nerv Syst 9 (2): 96–9. PMID 8319240.
- ↑ 3.0 3.1 Crooks DA (1991). "Pathogenesis and biomechanics of traumatic intracranial haemorrhages". Virchows Arch A Pathol Anat Histopathol 418 (6): 479–83. PMID 2058082.
- ↑ Beck J, Rohde S, Berkefeld J, Seifert V, Raabe A (January 2006). "Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography". Surg Neurol 65 (1): 18–25; discussion 25–7. doi:10.1016/j.surneu.2005.05.019. PMID 16378842.
- ↑ URL: http://stroke.ahajournals.org/cgi/content/abstract/24/7/987. Accessed on: 2 September 2010.
- ↑ Agostoni E, Aliprandi A, Longoni M (April 2009). "Cerebral venous thrombosis". Expert Rev Neurother 9 (4): 553–64. doi:10.1586/ern.09.3. PMID 19344306.
- ↑ URL: http://emedicine.medscape.com/article/1162804-overview. Accessed on: 12 October 2010.
- ↑ 8.0 8.1 URL: http://www.jpma.org.pk/full_article_text.php?article_id=932. Accessed on: 12 October 2010.
- ↑ Milandre L, Pellissier JF, Vincentelli F, Khalil R (1990). "Deep cerebral venous system thrombosis in adults". Eur. Neurol. 30 (2): 93–7. PMID 2187698.
- ↑ MSP. 12 October 2010.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 665. ISBN 978-1416054542.
- ↑ Choi, JC.; Kang, SY.; Kang, JH.; Park, JK. (Dec 2006). "Intracerebral hemorrhages in CADASIL.". Neurology 67 (11): 2042-4. doi:10.1212/01.wnl.0000246601.70918.06. PMID 17135568.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 663. ISBN 978-1416054542.