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Intracranial Haemorrhage

About Cranium

The human brain is protected by the skull called the Cranium. The cranium has the following layers

  • Scalp
  • Bone
  • Duramater
  • Arachnoids membrane
  • Arachnoids space
  • Pia mater
  • Brain tissue

Normal functioning of the brain requires normal intracranial pressure. This intracranial pressure is increased due to:-

  • Infection in brain/spinal cord
  • Space occupying lesions/Tumors
  • Head Injuries
  • Problems pertaining to blood vessels especially cerebral artery that supplies the blood to brain.

Types of Intracranial Hemorrhage

Intracranial Hemorrhage can broadly be divided in two sub types

  1. Extra - axial Hemorrhage
  2. Intra - axial Hemorrhage

Extra-axial Hemorrhage

It refers to the bleeding that occurs within the skull but outside brain tissue. It is further classified as follows:-

  1. Epidural hemorrhage
  2. Subdural Hemorrhage
  3. Sub arachnoid Hemorrhage

Epidural hemorrhage

It is the condition when hemorrhage occurs between skull and duramater. The source of bleeding is meningeal artery.

Most common causes include

  • head trauma
  • motor vehicle accidents
  • fall
  • assault

Clinical features

  • Altered consciousness
  • Headache
  • Vomiting
  • Confusion
  • Seizures
  • Aphagia

Subdural Hemorrhage

It is the condition when the bleeding occurs in between duramater and arachnoids membrane. The source of bleeding is usually venous blood.

Most common causes include

  • head trauma
  • motor vehicle accidents
  • fall
  • assault

Clinical features

  • Altered consciousness
  • Headache
  • Vomiting
  • Confusion
  • Seizures
  • Aphagia
  • Coma occurs in 50% of cases

Sub arachnoid Hemorrhage

The source of bleeding is aneurysm rupture (cerebral artery).

Most common causes include:-

  • Rupture of sacular aneurysm
  • Non aneurismal subarachnoid Hemorrhage

Clinical features:

  • Sudden severe headache
  • Vomiting
  • Seizure
  • Loss of vision
  • Meningismus

Intra-axial Haemorrhage

It is of the following types:-

  1. Intracerebral Hemorrhage
  2. Intraventricular Hemorrhage

Intracerebral Hemorrhage

It is further classified on the basis of location such as:-

  • Lobar Hemorrhage
  • Thalamic Hemorrhage
  • Pontine Hemorrhage
  • Cerebellar Hemorrhage

It is the second most common cause of Stroke (First being embolism/Thrombus formation).

Etiology

  • Hypertension
  • Embolism
  • Brain tumor
  • Bleeding disorders
  • Drugs

Clinical features

  • Neurological symptoms depending on the areas that is affected
  • Nausea/vomiting
  • Decreased level of consciousness

Intraventricular Hemorrhage

The condition happens when the bleeding occurs within the ventricles of brain. This most often occurs as a secondary phenomenon when intracerebral hemorrhage rupture or when subarachnoid hemorrhage extends the ventricles.

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