Intracranial hemorrhage classification
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Intracranial hemorrhage classification On the Web
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Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. Intracranial hemorrhage are roughly grouped into:
- Intra-axial hemorrhage (blood inside the brain)
- Extra-axial hemorrhage (blood inside the skull but outside the brain)
Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial.
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, 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 branch points 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.