Intracranial hemorrhage
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| Intracranial hemorrhage Classification and external resources | |
 | |
|---|---|
| ICD-10 | I60.0-I62., S06. |
| ICD-9 | 430-432, 850-854 |
| DiseasesDB | 6870 |
| MedlinePlus | 000796 |
| eMedicine | neuro/177 |
| MeSH | D020300 |
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An intracranial hemorrhage is a hemorrhage, or bleeding, within the skull.
Causes
Intracranial bleeding occurs when a blood vessel in the head is ruptured or leaks. It can result from physical trauma (as occurs in head injury) or nontraumatic causes (as occurs in hemorrhagic stroke) such as a ruptured aneurysm (ballooning blood vessel).
Complete Differential Diagnosis
Extradural Hemorrhage
- Rarely hemorrhage from a fracture gap, injured venous sinus or arachnoid villi
- Skull fracture
Intracerebral Hemorrhage
- After cerebral infarction
- Aneurysm
- Angioma
- Anticoagulant medication
- Hypertension
- Perinatal hemorrhage
- Trauma
- Tumor
- Risk Factors
- Anticoagulation medication
- Decreased platelet count
- Disseminated Intravascular Coagulation (DIC)
- Embolic strokes
- Hemophilia
- Hypertension
- Sickle Cell Anemia
Subarachnoid Hemorrhage
- Alcoholism
- Arteriovenous malformation
- Bacterial Endocarditis
- Brain tumor
- Fibromuscular Dysplasia (FMD)
- Hemorrhagic diathesis
- Hypertension
- Infections
- Leukemia
- Mycotic aneurysm
- Other aneurysms
- Other connective tissue diseases
- Polycystic kidney disease
- Ruptured intracerebral aneurysm
- Smoking
Subdural Hemorrhage
- Acute subdural hematoma
- Subacute subdural hematoma
- Usually due to head injury
- Risk Factors
- Alcoholism
- Anticoagulant medication
- Any disorder that results in falling
- Chronic use of aspirin
- Head injury
- Very young or advanced age
Diagnosis
CAT scan (computed axial tomography) is the definitive tool for accurate diagnosis of an intracranial hemorrhage.
Classification
Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial.
Intra-axial hemorrhage
Intra-axial hemorrhage is bleeding within the brain itself. This category includes:
- Intraparenchymal hemorrhage, or bleeding within the brain tissue.
- Intraventricular hemorrhage, bleeding within the brain's ventricles (particularly of premature infants).
Extra-axial hemorrhage
Extra-axial hemorrhage, bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes:
- Epidural hemorrhage is caused by trauma, and results from laceration of an artery, most commonly the middle meningeal artery. This is a very dangerous type of injury because the bleed is from a high-pressure system and deadly increases in intracranial pressure can result rapidly.
- Patients have a loss of consciousness (LOC), then a lucid interval, then sudden deterioration (vomiting, restlessness, LOC)
- Head CT shows lenticular (convex) deformity.
- Subdural hemorrhage results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater.
- Head CT shows crescent-shaped deformity
- Subarachnoid hemorrhage, like intraparenchymal hemorrhage, can result either from trauma or from ruptures of aneurysms or arteriovenous malformations. Blood is seen layering into the brain along sulci and fissures, or filling cisterns (most often the suprasellar cistern because of the presence of the vessels of the circle of Willis and their branchpoints within that space). The classic presentation of subarachnoid hemorrhage is the sudden onset of a severe headache. This can be a very dangerous entity, and requires emergent neurosurgical evaluation, and sometimes urgent intervention.
Prognosis
Intracranial hemorrhage is a serious medical emergency because the buildup of blood within the skull can lead to increases in intracranial pressure, which can crush delicate brain tissue or limit its blood supply. Intracranial bleeds with a lot of bleeding are more dangerous than those with not as much blood.
References
- Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York.
- McCaffrey P. 2001. "The Neuroscience on the Web Series: CMSD 336 Neuropathologies of Language and Cognition." California State University, Chico.
- Orlando Regional Healthcare, Education and Development. 2004. "Overview of Adult Traumatic Brain Injuries." Retrieved on September 6, 2007.
- Shepherd S. 2004. "Head Trauma." Emedicine.com.
- Vinas FC and Pilitsis J. 2004. "Penetrating Head Trauma." Emedicine.com.
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
