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Difference between revisions of "Intracranial hematomas"
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'''Intracranial | '''Intracranial [[hematoma]]s''', 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> | ||
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==Cerebral venous thrombosis== | ==Cerebral venous thrombosis== | ||
:See also: ''[[Thrombosis]]''. | |||
===General=== | ===General=== | ||
*Extremely rare. | *Extremely rare. | ||
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*Patient may have lucid interval.<ref name=pmid8319240>{{cite journal |author=Erşahin Y, Mutluer S, Güzelbag E |title=Extradural hematoma: analysis of 146 cases |journal=Childs Nerv Syst |volume=9 |issue=2 |pages=96–9 |year=1993 |month=April |pmid=8319240 |doi= |url=}}</ref> | *Patient may have lucid interval.<ref name=pmid8319240>{{cite journal |author=Erşahin Y, Mutluer S, Güzelbag E |title=Extradural hematoma: analysis of 146 cases |journal=Childs Nerv Syst |volume=9 |issue=2 |pages=96–9 |year=1993 |month=April |pmid=8319240 |doi= |url=}}</ref> | ||
*Classically due to an injury of the ''middle meningeal artery''. | *Classically due to an injury of the ''middle meningeal artery''. | ||
* | *Usually due to trauma. | ||
*Generally considered artefactual in the context of [[fire deaths]].<ref name=pmid2309533>{{Cite journal | last1 = Ritter | first1 = C. | title = [A heat gelatinized subdural hematoma in a burned cadaver as an indication of a vital accident]. | journal = Z Rechtsmed | volume = 103 | issue = 3 | pages = 227-30 | month = | year = 1990 | doi = | PMID = 2309533 }}</ref> | |||
=== | ===Gross=== | ||
*Blood outside of the dura. | |||
Radiology: | |||
*Biconvex. | *Biconvex. | ||
===Microscopic=== | |||
Features: | |||
*+/-Extravasated [[red blood cell]]s. | |||
*+/-Hemosiderin-laden macrophages. | |||
==Subdural hematoma== | ==Subdural hematoma== | ||
| Line 63: | Line 73: | ||
*+/-Trauma. | *+/-Trauma. | ||
*Elderly, esp. those with cerebral atrophy.<ref>{{Ref PCPBoD8|663}}</ref> | *Elderly, esp. those with cerebral atrophy.<ref>{{Ref PCPBoD8|663}}</ref> | ||
Recurrance risks: | |||
*[[Diabetes mellitus]].<ref name=pmid22653496>{{Cite journal | last1 = Chon | first1 = KH. | last2 = Lee | first2 = JM. | last3 = Koh | first3 = EJ. | last4 = Choi | first4 = HY. | title = Independent predictors for recurrence of chronic subdural hematoma. | journal = Acta Neurochir (Wien) | volume = 154 | issue = 9 | pages = 1541-8 | month = Sep | year = 2012 | doi = 10.1007/s00701-012-1399-9 | PMID = 22653496 }}</ref> | |||
===Gross=== | ===Gross=== | ||
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Features: | Features: | ||
*Blood in subdural (potential) space. | *Blood in subdural (potential) space. | ||
====Images==== | |||
<gallery> | |||
Image:Subdural_hematoma_-_very_low_mag.jpg | SDH - very low mag. (WC) | |||
Image:Subdural_hematoma_-_intermed_low_mag.jpg | SDH - intermed. mag. (WC) | |||
</gallery> | |||
==Subarachnoid hematoma== | ==Subarachnoid hematoma== | ||
| Line 77: | Line 96: | ||
===General=== | ===General=== | ||
*In the [[forensic pathology|forensic]] context ''SAH'' alone is not good enough. | *In the [[forensic pathology|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. | **One needs to determine the cause, e.g. ruptured [[berry aneurysm]] ''or'' laceration of left vertebral artery. | ||
DDx: | |||
*Trauma - most common, see section below. | |||
*Ruptured [[berry aneurysm]] ~80% of non-traumatic SAH.<ref>{{Cite journal | last1 = Ingelmo Ingelmo | first1 = I. | last2 = Fàbregas Julià | first2 = N. | last3 = Rama-Maceiras | first3 = P. | last4 = Hernández-Palazón | first4 = J. | last5 = Rubio Romero | first5 = R. | last6 = Carmona Aurioles | first6 = J. | title = [Subarachnoid hemorrhage: epidemiology, social impact and a multidisciplinary approach]. | journal = Rev Esp Anestesiol Reanim | volume = 57 Suppl 2 | issue = | pages = S4-15 | month = Dec | year = 2010 | doi = | PMID = 21298906 }} | |||
</ref> | |||
*[[Arteriovenous malformation]] and other vascular anomalies. | |||
====Traumatic SAH==== | ====Traumatic SAH==== | ||
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Note: | Note: | ||
*Ruptured berry aneurysms are best found when the brain is fresh; it is hard to dissect away fixed blood. | *Ruptured [[berry aneurysms]] are best found when the brain is fresh; it is hard to dissect away fixed blood. | ||
==Intracerebral hematoma== | ==Intracerebral hematoma== | ||
| Line 94: | Line 119: | ||
===General=== | ===General=== | ||
Causes:<ref>{{Ref PCPBoD8|665}}</ref> | Causes:<ref>{{Ref PCPBoD8|665}}</ref> | ||
*[[Hypertension]]. | *[[Hypertension]] - usually putamen, thalamus, pons, cerebellum - see ''[[hypertension#Intracerebral_hematoma|intracerebral hematoma in hypertension]]''. | ||
*[[Cerebral amyloid angiopathy]]. | *[[Cerebral amyloid angiopathy]] - usually superficial (cortex & subcortical white matter) & frontal lobe or parietal lobe.<ref name=pmid17297004>{{Cite journal | last1 = Haacke | first1 = EM. | last2 = DelProposto | first2 = ZS. | last3 = Chaturvedi | first3 = S. | last4 = Sehgal | first4 = V. | last5 = Tenzer | first5 = M. | last6 = Neelavalli | first6 = J. | last7 = Kido | first7 = D. | title = Imaging cerebral amyloid angiopathy with susceptibility-weighted imaging. | journal = AJNR Am J Neuroradiol | volume = 28 | issue = 2 | pages = 316-7 | month = Feb | year = 2007 | doi = | PMID = 17297004 | URL = http://www.ajnr.org/content/28/2/316.long }}</ref> | ||
*[[Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy]] (CADASIL).<ref name=pmid17135568>{{Cite journal | last1 = Choi | first1 = JC. | last2 = Kang | first2 = SY. | last3 = Kang | first3 = JH. | last4 = Park | first4 = JK. | title = Intracerebral hemorrhages in CADASIL. | journal = Neurology | volume = 67 | issue = 11 | pages = 2042-4 | month = Dec | year = 2006 | doi = 10.1212/01.wnl.0000246601.70918.06 | PMID = 17135568 }}</ref> | *[[Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy]] (CADASIL).<ref name=pmid17135568>{{Cite journal | last1 = Choi | first1 = JC. | last2 = Kang | first2 = SY. | last3 = Kang | first3 = JH. | last4 = Park | first4 = JK. | title = Intracerebral hemorrhages in CADASIL. | journal = Neurology | volume = 67 | issue = 11 | pages = 2042-4 | month = Dec | year = 2006 | doi = 10.1212/01.wnl.0000246601.70918.06 | PMID = 17135568 }}</ref> | ||
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*+/-Hemosiderin-laden macrophages. | *+/-Hemosiderin-laden macrophages. | ||
== | ==Cerebral fat embolism== | ||
* | ===General=== | ||
* | *Etiology: trauma. | ||
* | *May be associated with [[pulmonary fat embolism]]. | ||
===Gross=== | |||
Features:<ref name=pmid7423578>{{Cite journal | last1 = Kamenar | first1 = E. | last2 = Burger | first2 = PC. | title = Cerebral fat embolism: a neuropathological study of a microembolic state. | journal = Stroke | volume = 11 | issue = 5 | pages = 477-84 | month = | year = | doi = | PMID = 7423578 }} | |||
</ref> | |||
*Multiple white matter predominant petechiae. | |||
DDx - medical imaging: | |||
*[[Diffuse axonal injury]]<ref name=pmid22406792>{{Cite journal | last1 = Kumar | first1 = S. | last2 = Gupta | first2 = V. | last3 = Aggarwal | first3 = S. | last4 = Singh | first4 = P. | last5 = Khandelwal | first5 = N. | title = Fat embolism syndrome mimicker of diffuse axonal injury on magnetic resonance imaging. | journal = Neurol India | volume = 60 | issue = 1 | pages = 100-2 | month = | year = | doi = 10.4103/0028-3886.93597 | PMID = 22406792 }}</ref> - severe DAI classically has a corpus callosum injury. | |||
*Herpes simplex encephalitis - temporal lobe hemorrhage. | |||
Images: | |||
*[http://www.duke.edu/~ema5/Golian/Slides/3/fluids-hemo_files/flh212.jpg FE (duke.edu)].<ref>URL: [http://www.duke.edu/~ema5/Golian/Slides/3/fluids-hemo.htm http://www.duke.edu/~ema5/Golian/Slides/3/fluids-hemo.htm]. Accessed on: 25 March 2012.</ref> | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132375/figure/F2/ Cerebral fat embolism (nih.gov)].<ref>{{Cite journal | last1 = Eriksson | first1 = EA. | last2 = Schultz | first2 = SE. | last3 = Cohle | first3 = SD. | last4 = Post | first4 = KW. | title = Cerebral fat embolism without intracardiac shunt: A novel presentation. | journal = J Emerg Trauma Shock | volume = 4 | issue = 2 | pages = 309-12 | month = Apr | year = 2011 | doi = 10.4103/0974-2700.82233 | PMID = 21769222 | PMC = 3132375}}</ref> | |||
===Microscopic=== | |||
Features:<ref name=pmid7423578/> | |||
*Intravascular fat globules. | |||
==See also== | ==See also== | ||