4Spontaneous hemorrhage: Etiology A . Intracerebral (intraparenchymal) - predominantly, hypertensive.B. Subarachnoid - predominantly, aneurysmal.C. Mixed intracerebral and subarachnoid - usually associated with rupture of arteriovenous malformations.
5Spontaneous Intracerebral / intraparenchymal hemorrhage AGE : MIDDLE TO LATE ADULT LIFEPICK AGE : 60 YEARSCause:1.Acute and chronic raise of blood pressure.2. Rupture of Charcot – Bouchard microaneurysm50 % of all hemorrhage
6If the patient is on anticoagulant therapy Spontaneous Intracerebral / intraparenchymal hemorrhageRisk factors:It can develop in an ischemic Infract particularly if reperfusion occur.If the patient is on anticoagulant therapyIn case of Amyloid angiopathy.Location:Putamen – 60%ThalamusPons
7Hemorrhages involving the basal ganglia area ; Hypertensive hemorrhage
8Rupture of Charcot – Bouchard microaneurysm IT IS A FEATURE OF CHRONIC HYPERTANSIONInvolve a vessels less than 300micrometer in Diameter.SITE: BASAL GANGLIA
9Complication of Intracranial hemorrhage Mass effect can cause HerniationSecondary Brain stem or Duret hemorrhage
10Clinical Features : Hypertensive hemorrhage Sudden loss of consciousnessVomiting, Headache [ increased intracranial pressure ]EFFECT OF BRAIN STEM COMPRESSIONIRREGULAR RESPIRATIONPERIOD OF APNEA [ CHEYNE STROKE BREATHING]DILATED NONRESPONSIVE PUPILSPASTICITY
11SUBARACHONOID HAEMORRHAGE Etiology:RUPTURE OF SACCULAR Aneurysm ( Berry aneurysm )Size: 6-10 mm.
12Berry aneurysmBerry aneurysms arise in a weak (ness) point in the arterial wall (media).Disease associated: Marfan syndrome, Ehlar Danlos, Adult polycystic kidney disease.Angiogram
13Circle of Willis : And the sites of berry aneurysm.
14Morphology If less than 3 mm in diameter = asymptomatic. 30 % Cases multiple.CSF : will show blood.
16Clinical features : Subarachnoid Hemorrhage Women are effected more than male.Giant aneurysm > 25 mm in diameter.It gradually enlarges from child hood, become large enough to produce symptoms in adulthood by sudden increased blood pressure.
17Clinical Signs : In subarachnoid Hemorrhage. Headache, come , vomiting is present, herniation, acute Hydrocephalous.Additional features:EVIDENCE OF MENINGIAL IRITATION IS PRESENT1. NECK RIGIDITY2. BLOODY CSF
18Mixed intracerebral and subarachnoid hemorrhage Cause: Vascular malformations.This are 4 TYPESARTERIOVANOUS MALFORMATIONCAPILLARY TELANGECTASISVENOUS ANGIOMACAVERNOUS ANGIOMA
19ARTERIOVANOUS MALFORMATION Common in the cerebral hemispheres. Males are affected twice as often as females.AGE = 10 – 30
20“HAPHAZARDLY ARRANGED BLOOD VESSELS, CONTAINING ARTERIES AND VEINS AND TRANSITIONAL FORMS OF THE VESSELS”.Microscopy
35Concussion It is associated with minimum morphological change. Unconsciousness is due to the injury to the Reticular activating System.
36Contusion and Laceration Contusion = Injury to the Superficial Brain parenchyma due to the Blunt trauma.Laceration = CONTUSION + TEAR OF THE SUPERFICIAL LAYERS OF THE BRAIN.
37Injury Directly beneath the area of blunt force: no skull fracture Coup ContusionHit on Immobile HeadInjury Directly beneath the area of blunt force: no skull fracture
38Injury in the Frontal and temporal poles area in a mobile head. Contrecoup contusionINJURYIn fall if the occipital area strikes the floorInjury in the Frontal and temporal poles area in a mobile head.
39LacerationCONTUSION + TEAR OF THE SUPERFICIAL LAYERS OF THE BRAIN.
40Traumatic Intracerebral hemorrhage Multiple often associate with contusion and edema of the Brain.
41Diffuse axonal injury Injury to white matter Damage to axon at node of Ranvier.Common sites:Corpus callosum, periventricular area, hippocampus.Clinical: coma after trauma without evicence of parenchymal injury.Histology: axonal swelling.
42Spinal cord injury: location Lesion to thoracic segmentParaplegiaLesion to cervical segmentTetraplagiaAbove C4Respiratory arrest due to paralysis of diaphram