Intracranial hematomas

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Intracranial hematomas 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

  1. Epidural hemorrhage (extradural hemorrhage).
    • Patient may have lucid interval.[2]
    • Middle meningeal artery.
    • Radiology: biconvex.
  2. Subdural hemorrhage
    • Damaged bridging veins: subdural space between the dura and arachnoid mater.[3]
    • Radiology: crescent shape.
  3. Subarachnoid hemorrhage.
    • Classically caused by aneuryms:[4]
      1. Anterior communicating artery (ACA) - most common.
      2. Middle cerebral artery (MCA) - second most common.
  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

Features:[9][10]

  • Bilateral involvement.
  • Congested appearance.

Subarachnoid hemorrhage

  • Abbreviated SAH.

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

Cerebellar white mater predominant petechial hemorrhage

  • AKA brain purpura.
  • Etiology: fat embolism syndrome secondary to trauma.
  • Image: FE (med.utah.edu).

See also

References

  1. McAuliffe. 15 October 2010.
  2. Erşahin Y, Mutluer S, Güzelbag E (April 1993). "Extradural hematoma: analysis of 146 cases". Childs Nerv Syst 9 (2): 96–9. PMID 8319240.
  3. Crooks DA (1991). "Pathogenesis and biomechanics of traumatic intracranial haemorrhages". Virchows Arch A Pathol Anat Histopathol 418 (6): 479–83. PMID 2058082.
  4. 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.
  5. URL: http://stroke.ahajournals.org/cgi/content/abstract/24/7/987. Accessed on: 2 September 2010.
  6. 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.
  7. URL: http://emedicine.medscape.com/article/1162804-overview. Accessed on: 12 October 2010.
  8. 8.0 8.1 URL: http://www.jpma.org.pk/full_article_text.php?article_id=932. Accessed on: 12 October 2010.
  9. Milandre L, Pellissier JF, Vincentelli F, Khalil R (1990). "Deep cerebral venous system thrombosis in adults". Eur. Neurol. 30 (2): 93–7. PMID 2187698.
  10. MSP. 12 October 2010.