Intracranial hematomas

Intracranial hematomas are bad stuff that keep neurosurgeons busy. They are usually diagnosed by imaging (CT head).

Classification

By location

1. Epidural hemorrhage (extradural hemorrhage).
   • Patient may have lucid interval.
   • Middle meningeal artery.
   • Radiology: biconvex.
2. Subdural hemorrhage
   • Damaged bridging veins: subdural space between the dura and arachnoid mater.
   • Radiology: crescent shape.
3. Subarachnoid hemorrhage.
   • Classically caused by aneuryms:
     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.

By vessel type

• Arterial - common.
• Venous - rare (~3-4 cases/1,000,000 people/year

Cerebral venous thrombosis

General

Features:

• Extremely rare.
• Female > male.
• May be associated with trauma.
• Presentation often mimics subarachnoid haemorrhage.

Gross

Features:

• Bilateral involvement.
• Congested appearance.

Subarachnoid hemorrhage

General

• Abbreviated SAH.

Traumatic SAH

• May have a characteristic mastoid contusion.
  • May be associated with vascular Ehlers-Danlos syndrome.

Cerebellar white mater predominant petechial hemorrhage

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

See also

• Forensic pathology.
• Neuropathology.
• Hypertension.