NEURO - Intracranial Hemorrhage

Question 1

Epidural hematoma

Answer 1

Rupture of middle meningeal artery often 2° to skull fracture

• biconvex (lentiform), hyperdense blood collection *not crossing suture lines.
• blood btw dura and skull
• Lucid interval

Rapid expansion under systemic arterial pressure–> Ž transtentorial herniation, CN
III palsy

Question 2

Subdural hematoma

Answer 2

Rupture of bridging veins
*slow venous bleeding)

• Crescent-shaped hemorrhage that crosses suture lines
• Can cause midline shift
• Cannot cross fall, tentorium

*blood btw dura and arachnoid layer

Predisposing factors: brain atrophy, trauma, shaken babies, alcoholics, elderly.

Question 3

Subarachnoid hemorrhage

Answer 3

Rupture of an aneurysm (such as a saccular aneurysm) or arteriovenous malformation

• blood btw arachnoid and pia layer
• blood everywhere on CT
• sometimes blood not visible on CT

Rapid time course.

Patients complain of “worst headache of my life.” (WHOML)

Bloody or yellow (*xanthochromic) spinal tap.

INC risk of developing communicating and/
or obstructive hydrocephalus.

Question 4

Intraparenchymal (Hypertensive)

hemorrhage

Answer 4

Most commonly caused by systemic hypertension

May be 2º to reperfusion injury in ischemic stroke

Typically occurs in basal ganglia G and internal capsule (Charcot-Bouchard
aneurysm of lenticulostriate vessels), but can be lobar