Difference between revisions of "Intracranial hematomas"

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-'''Intracranial hematomas''' are bad stuff that keep neurosurgeons busy.  They are usually diagnosed by imaging (CT head).
+'''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>
+==Clinical==
+*Headache.
+*Neck stiffness.
+*Vomit without diarrhea.
+*Changes in level of consciousness.
 ==Classification==
+===By location===
 # Epidural hemorrhage (extradural hemorrhage).
 #* 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>
 #* Middle meningeal artery.
-#* Radiology: ellipsoid shape.
+#* Radiology: biconvex.
 # Subdural hemorrhage
-#* Damaged bridging veins: subdural space between the dura and arachnoid mater.
+#* Damaged bridging veins: subdural space between the dura and arachnoid mater.<ref name=pmid2058082>{{cite journal |author=Crooks DA |title=Pathogenesis and biomechanics of traumatic intracranial haemorrhages |journal=Virchows Arch A Pathol Anat Histopathol |volume=418 |issue=6 |pages=479–83 |year=1991 |pmid=2058082 |doi= |url=}}</ref>
 #* Radiology: crescent shape.
 # Subarachnoid hemorrhage.
@@ Line 14: / Line 23: @@
 #*#Middle cerebral artery (MCA) - second most common.
 # Intracerebral hemorrhage.
+#* > 60 ml at presentation (assessed via CT scan) assoc. with > 90% 30 day mortality.<ref>URL: [http://stroke.ahajournals.org/cgi/content/abstract/24/7/987 http://stroke.ahajournals.org/cgi/content/abstract/24/7/987]. Accessed on: 2 September 2010.</ref>
+===By vessel type===
+*Arterial - common.
+*Venous - rare (~3-4 cases/1,000,000 people/year<ref name=pmid19344306>{{cite journal |author=Agostoni E, Aliprandi A, Longoni M |title=Cerebral venous thrombosis |journal=Expert Rev Neurother |volume=9 |issue=4 |pages=553–64 |year=2009 |month=April |pmid=19344306 |doi=10.1586/ern.09.3 |url=}}</ref>).
+==Cerebral venous thrombosis==
+:See also: ''[[Thrombosis]]''.
+===General===
+*Extremely rare.
+*Female > male.
+*May be associated with trauma.<ref>URL: [http://emedicine.medscape.com/article/1162804-overview http://emedicine.medscape.com/article/1162804-overview]. Accessed on: 12 October 2010.</ref>
+*Presentation often mimics subarachnoid haemorrhage.<ref name=jpma>URL: [http://www.jpma.org.pk/full_article_text.php?article_id=932 http://www.jpma.org.pk/full_article_text.php?article_id=932]. Accessed on: 12 October 2010.</ref>
+*Typically involves superior sagittal sinus.<ref name=jpma/>
+===Gross===
+Features:<ref name=pmid2187698>{{cite journal |author=Milandre L, Pellissier JF, Vincentelli F, Khalil R |title=Deep cerebral venous system thrombosis in adults |journal=Eur. Neurol. |volume=30 |issue=2 |pages=93–7 |year=1990 |pmid=2187698 |doi= |url=}}</ref><ref>MSP. 12 October 2010.</ref>
+*Bilateral involvement.
+*Congested appearance.
+==Epidural hematoma==
+*[[AKA]] ''epidural hemorrhage''
+===General===
+*Extradural hemorrhage.
+*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''.
+*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.
+===Microscopic===
+Features:
+*+/-Extravasated [[red blood cell]]s.
+*+/-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.<ref name=pmid2058082>{{cite journal |author=Crooks DA |title=Pathogenesis and biomechanics of traumatic intracranial haemorrhages |journal=Virchows Arch A Pathol Anat Histopathol |volume=418 |issue=6 |pages=479–83 |year=1991 |pmid=2058082 |doi= |url=}}</ref>
+Why?
+*+/-Trauma.
+*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===
+*Blood in the subdural potential space.
+*Crescentic shape.
+===Microscopic===
+Features:
+*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==
+*Abbreviated ''SAH''.
+*[[AKA]] ''subarachnoid hemorrhage''.
+===General===
+*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.
+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====
+*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:<ref>{{Ref PCPBoD8|665}}</ref>
+*[[Hypertension]] - usually putamen, thalamus, pons, cerebellum - see ''[[hypertension#Intracerebral_hematoma|intracerebral hematoma in hypertension]]''.
+*[[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>
+===Gross===
+*Blood within the parenchyma of the brain.
+===Microscopic===
+*+/-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==
+*[[Cerebral amyloid angiopathy]].
+*[[Duret hematoma]].
 *[[Forensic pathology]].
+*[[Hypertension]].
 *[[Neuropathology]].
+*[[Scalp hematomas]].
 ==References==

Difference between revisions of "Intracranial hematomas"

Intracranial hematomas (view source)

Revision as of 07:14, 9 December 2014

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