Difference between revisions of "Intracranial hematomas"
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===Gross=== | ===Gross=== | ||
*Blood | *Blood within the parenchyma of the brain. | ||
===Microscopic=== | ===Microscopic=== | ||
Revision as of 22:14, 26 November 2011
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
- Epidural hemorrhage (extradural hemorrhage).
- Patient may have lucid interval.[2]
- Middle meningeal artery.
- Radiology: biconvex.
- Subdural hemorrhage
- Damaged bridging veins: subdural space between the dura and arachnoid mater.[3]
- Radiology: crescent shape.
- Subarachnoid hemorrhage.
- Classically caused by aneuryms:[4]
- Anterior communicating artery (ACA) - most common.
- Middle cerebral artery (MCA) - second most common.
- Classically caused by aneuryms:[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
- 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
- May have a characteristic mastoid contusion.
- May be associated with vascular Ehlers-Danlos syndrome.
Intracerebral hemorrhage
- AKA intraparenchymal hemorrhage.
General
Causes:[11]
- Hypertension.
- Cerebral amyloid angiopathy.
- Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).
Gross
- Blood within the parenchyma of the brain.
Microscopic
- +/-Hemosiderin-laden macrophages.
Cerebellar white mater predominant petechial hemorrhage
- AKA brain purpura.
- Etiology: fat embolism syndrome secondary to trauma.
- Image: FE (med.utah.edu).
See also
References
- ↑ McAuliffe. 15 October 2010.
- ↑ Erşahin Y, Mutluer S, Güzelbag E (April 1993). "Extradural hematoma: analysis of 146 cases". Childs Nerv Syst 9 (2): 96–9. PMID 8319240.
- ↑ Crooks DA (1991). "Pathogenesis and biomechanics of traumatic intracranial haemorrhages". Virchows Arch A Pathol Anat Histopathol 418 (6): 479–83. PMID 2058082.
- ↑ 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.
- ↑ URL: http://stroke.ahajournals.org/cgi/content/abstract/24/7/987. Accessed on: 2 September 2010.
- ↑ 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.
- ↑ URL: http://emedicine.medscape.com/article/1162804-overview. Accessed on: 12 October 2010.
- ↑ 8.0 8.1 URL: http://www.jpma.org.pk/full_article_text.php?article_id=932. Accessed on: 12 October 2010.
- ↑ Milandre L, Pellissier JF, Vincentelli F, Khalil R (1990). "Deep cerebral venous system thrombosis in adults". Eur. Neurol. 30 (2): 93–7. PMID 2187698.
- ↑ MSP. 12 October 2010.
- ↑ 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.