Intracranial Haemorrhages

Intracerebral Extracerebral
Extradural (epidural) haemorrhage

Arterial bleeding
Bleeding from middle meningeal artery
Following a hard blow to the head
Blood collects between dura mata and skull
Extradural haematoma is formed
Haematoma biconvex in shape
Brain compression and death if not evacuated
 Lucid interval
• Epidural hemorrhage shows following
sequence of events:
• Initial confusion-> reduced consciousness->
lucid interval-> change in mental status
(confused/ drowsy/ neurologic signs)
• Lucid interval: bried period of full
consciousness/ restored mental status. The
patients seems back to his/ her “normal
self”
Middle meningeal
artery
 Subdural haematoma
Venous bleeding
Bleeding due to tearing of cerebral veins as
they enter superior sagittal sinus
Following a blow to the head that jerks the
brain inside the cranial cavity
Incident is usually long before and forgotten
Blood collects between dura mata and
arachnoid mater
Subdural haematoma is sickle shaped
 Treatment
• Small SDH- Conservative management
• Large or symptomatic- craniotomy
 Subarachnoid haemorrhage
Usually arterial bleeding
Bleeding from internal carotid and circle of willis arteries
Due to arterial aneurysms (ruptured due to high blood
pressure)
Blood collects in the subarachnoid space stroke and
increased ICP
CSF gets mixed with blood----Xanthochromasia
Severe headache (“worst headache of my life”) and neck
stiffness due to meningeal irritation
 Risk Factors
• Behavioural: Hypertension, smoking,
alcohol, drug abuse, low BMI
• Non behavioural: Female, p/h of SAH,
family history, advanced age
 Diagnosis and Management
• Gold standard: NCCT brain
• CT- “star sign”
• Lumbar puncture: xanthochromasia
• Medical- analgesics, triple H therapy-
hypervolemia, hypertension, hemodilution,
smooth muscle relaxants, CCBs
• Elevaed ICP-
• Tracheal intubation, acute hyperventilation
• Mannitol
• Elevation of head end of bed
• CSF drainage
• Control BP
 Sequence of events following head injury and
raised intracranial pressure

Initial concussion
Lucid interval
Drowsiness
Pupils initially constrict then dilated and fixed
Pulse initially may increase then reduce
BP increases with reducing pulse (cushing reflex)
Should monitor BP, pulse, respiration and pupils