Intracranial hematomas

From Libre Pathology
Revision as of 05:27, 25 March 2012 by Michael (talk | contribs) (→‎Epidural hematoma: expand, add note about artefactual--- in fire)
Jump to navigation Jump to search

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

  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

See also: 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.

Epidural hematoma

  • AKA epidural hemorrhage

General

  • Extradural hemorrhage.
  • Patient may have lucid interval.[2]
  • Classically due to an injury of the middle meningeal artery.
  • Usually due to trauma.
  • Generally considered artefactual in the context of fire deaths.[11]

Gross

  • Blood outside of the dura.

Radiology:

  • Biconvex.

Microscopic

Features:

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.[12]

Gross

  • Blood in the subdural potential space.
  • Crescentic shape.

Microscopic

Features:

  • Blood in subdural (potential) space.

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

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:[13]

Gross

  • Blood within the parenchyma of the brain.

Microscopic

  • +/-Hemosiderin-laden macrophages.

Cerebral fat embolism

General

Gross

Features:[15]

  • Multiple white matter predominant petechiae.

DDx - medical imaging:

Image:

Microscopic

Features:[15]

  • Intravascular fat globules.

See also

References

  1. ↑ McAuliffe. 15 October 2010.
  2. ↑ 2.0 2.1 Erşahin Y, Mutluer S, Güzelbag E (April 1993). "Extradural hematoma: analysis of 146 cases". Childs Nerv Syst 9 (2): 96–9. PMID 8319240.
  3. ↑ 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.
  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.
  11. ↑ Ritter, C. (1990). "[A heat gelatinized subdural hematoma in a burned cadaver as an indication of a vital accident].". Z Rechtsmed 103 (3): 227-30. PMID 2309533.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 15.0 15.1 Kamenar, E.; Burger, PC.. "Cerebral fat embolism: a neuropathological study of a microembolic state.". Stroke 11 (5): 477-84. PMID 7423578.
  16. ↑ Kumar, S.; Gupta, V.; Aggarwal, S.; Singh, P.; Khandelwal, N.. "Fat embolism syndrome mimicker of diffuse axonal injury on magnetic resonance imaging.". Neurol India 60 (1): 100-2. doi:10.4103/0028-3886.93597. PMID 22406792.
  17. ↑ URL: http://www.duke.edu/~ema5/Golian/Slides/3/fluids-hemo.htm. Accessed on: 25 March 2012.
Retrieved from "https://librepathology.org/w/index.php?title=Intracranial_hematomas&oldid=14045"