Intracranial Bleeding – Pathology

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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

 

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