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Brain Hemorrhage

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Posted by on Saturday, March 5, 2011, 5:50
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Brain Hemorrhage
Brain Hemorrhage

It is the hemorrhage or bleeding within the skull. It usually results from a rupture of blood vessel within the brain parenchyma.

(1)    Intra axial Hemorrhage        (2) Extra axial Hemorrhage

(1)     Intra axial Hemorrhage:  It is bleeding within the brain itself. (cerebral hemorrhage)
It is further classified into
a.    Intraparenchymal Hemorrhage        b. Intarventricular Hemorrhage

a.    Intraparenchymal Hemorrhage: bleeding within the brain tissue.
b.    Intarventricular Hemorrhage:   bleeding within brain ventricles.

Causes & Risk factors:
•    Old age
•    Hypertension
•    Di-bêtes
•    Smoking
•    ATH
•    High cholesterol level

(2)    Extra axial Hemorrhage: In it bleeding occur within the skull, but outside the brain tissue.
It is further classified into
a.    Epidural Hematoma
b.     Subdural Hematoma
c.     Sub arachnoid Hematoma

a.    Epidural Hematoma: This is the collection of blood which forms between the skull and Dura. Patient presents with sub-acute impairment of brain function both globally and locally. Most commonly the injuries are associated with rupture of middle meningeal artery.
CT scan Appearance: CT shows a lenticular or convex lens shaped extra cerebral hemorrhage.
Prognosis: Death is a potential complication but prognosis is good when injury is recognized & treated.

b.    Subdural Hematoma: It is rapidly accumulating hematoma between Dura & arachnoid. Pt. presents us with gradually increasing headache & confusion. Clinical features depends upon sites & severity of injury. Pt. may have history of loss of consciousness but may recover & do not relapse.
CT scan Appearance:  CT scan shows crescent shaped hemorrhage compressing the brain.

c.    Sub arachnoid Hematoma: It is bleeding into subarachnoid space (the area between arachnoid membrane & pia matter). Besides from injury, it may occur spontaneously usually from a ruptured cerebral aneurysm.

Signs & Symptoms:
•    Sudden & severe headache
•    Vomiting
•    Loss of consciousness
•    On examination, Pt. is usually distressed and irritable with photophobia.
•    There may be neck stiffness due to subarachnoid blood.
•    3rd nerve palsy due to local pressure from an aneurysm of posterior communicating artery, may be present.

Management & Prognosis:
•    Mortality rate of aneurysmal sub arachnoid hematoma is 30%. Survivors have a recurrence or rebleed rate of about 4%.
•    Insertion of platinum coils into an aneurysm or surgical clipping of aneurysm.

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