Intracranial hemorrhage classification

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Intracranial hemorrhage Microchapters




Intra-Axial Hemorrhage
Extra-Axial Hemorrhage



Differentiating Intracranial Hemorrhage from other Diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. Intracranial hemorrhage are roughly grouped into:


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:

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 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.