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Intracranial hemorrhages Siti hazaimah
Intracranial hemorrhages Classification in function of location: - Epidural - Subdural - Subarachnoid - Intracerebral/ Intraparenchymal
Epidural Hematoma -Etiology: trauma → skull fracture (temporo- parietal bone) → tear of Middle Meningeal Artery.
Epidural Hematoma -Epidemiology: 0.5% head injuries young adult, male to female 4:1 -Presentation: 1.Initial LOC 2.“Lucid interval” for several hours 3.Obtundation, CL Hemiparesis, IL pupil dilation
Epidural Hematoma - Evaluation: CT brain non-contrast 84% high density biconvex (lenticular) 40% have no identifiable skull fractures. - Prognosis: good with early intervention
Epidural Hematoma -Treatment: 1.Medical management if <1cm and no neuro signs 2.Surgery (craniotomy): any symptomatic EDH. -Clot removal to ↓ ICP -Hemostasis -Prevent re-accumulation
Subdural Hematoma -Etiology: violent head mvt. → accel-deccel of brain in cranium → tear of Bridging veins.
Subdural Hematoma -Epidemiology: 30% head injuries. ↑ risk in elderly and infants -Presentation: 1.Headache, confusion, lethargy 2.+/- focal signs 3.Slowly progressive neurological decompensation.
Subdural Hematoma - Evaluation: CT brain non-contrast Crescentic mass -A =Hyderdense: 1-3d -Sub-A=Isodense: 4d-3wk -C =Hypodense: 3wk-4mo - Prognosis: Mortality 50- 90%; due to underlying brain injury.
Subdural Hematoma -Treatment: 1.Rapid surgical evacuation with craniotomy for symptomatic patients. 2.Subdural drain in neurologically stable patient. 3.Observation if less than <1cm
Subarachnoid Hemorrhage -Etiology: cerebral artery injury (aneurysm/ AVM rupture, trauma) → blood leakage in SA space → meningeal irritation.
Subarachnoid Hemorrhage -Epidemiology: most common head injury. Aneurysm peak 55-60yrs. -Presentation: 1.“The worst HA of my life” 2.Meningismus 3.Focal neurological deficits 4.Obtundation to coma
Subarachnoid Hemorrhage Evaluation: CT brain non-contrast → LP → Angiogram Blood in sulci and cisterns Xanthochromia - Prognosis: Mortality 32- 67%.
Subarachnoid Hemorrhage -Treatment: 1.Surgical intervention directed at stopping the bleeding and lowering ICP. 2.Medical management of complication (vasospasm, stoke)
Intraparenchymal Hemorrhage -Etiology: Intracerebral artery injury (aneurysm/ AVM rupture, arteriopathy, HTN, trauma), hemorrhagic stroke.
Intraparenchymal Hemorrhage -Epidemiology: men, >55yo, blacks, h/o HTN, h/o CVA, alcohol consumption, smoking, drug use. -Presentation: greatly varies in function of the location. Onset during activity.
Intraparenchymal Hemorrhage - Evaluation: Brain CT /MRI/Angio Hemorrhage: -lobar - Internal capsule - Ganglio-thalamic - Pontine - Prognosis: Highly variable.
Intraparenchymal Hemorrhage -Treatment: 1.Medical management (BP control, hemostasis). 2. Surgical intervention is controversial.
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