Introduction
Intracranial bleeding can be traumatic or non-traumatic. In some situations the trauma can be relatively minor e.g. chronic sub-dural haematoma. Some lesions can occur in either e.g. subarachnoid haemaorrhage, intracerebral haemorrhage. Some are almost exclusively traumatic e.g. extra-dural. Some are seen more in certain age groups e.g. neonatal peri-ventricular haemorrhage. The lesion is normally obviously on neuro-imaging. Treatment and prognosis depend on site, size, cause, location and clinical impact.
Radiological Classification by Locations
- Extra-axial (outside of brain tissue) – Extradural haematoma, Sub-dural haematoma
- Intra-axial (within brain tissue) – Subarachnoid hamatoma, Intra-cerebral haematoma, parenchymal haematoma, lobar haematoma Peri-ventricular haematoma, Intra-ventricular haematoma
Prognostic factors (do better and better candidates for surgery)
- Not comatose at presentation
- No focal deficit
- Younger age
- Extra-axial bleeds
- Posterior fossa bleeds
- No intraventricular blood
- No clinical or radiological evidence of herniation
- Underlying cause easier to treat e.g. cerebral aneurysm