Simple & Specific Series
Intra Cranial Hemorrhage
Dr. Omar M. Sultan
MBChB, MSc Radiology
Intracranial Haemorrhage
• Intracranial hemorrhage
is characterized
by the extra-vascular accumulation of blood
within different intracranial spaces.
• A simple categorization is based on
location:
– intra-axial (inside brain parenchyma)
– extra-axial (outside brain parenchyma)
Intracranial Haemorrhage
• Simple categorization is based on location:
1. Intra-axial (inside brain parenchyma)
– Intra cerebral
– Intra cerebeller
– Intra ventricular
2. Extra-axial (outside brain parenchyma)
– Extra dural haemorrhage (EDH)
– Sub dural haemorrhage (SDH)
– Sub arachnoid haemorrhage (SAH)
Causes of ICH
• Trauma
– Extra-dural haemorrhage (EDH)
– Sub-dural haemorrhage (SDH)
– Sub-arachnoid haemorrhage (SAH)
– Cerebral hemorrhagic contusion
• Vascular malformation(s)
– berry aneurysm
– mycotic aneurysm
– arteriovenous malformation (AVM)
– dural arteriovenous fistula (DAVF)
• Tumour related haemorrhage
• Hypertension:
hypertensive haemorrhage
• Cerebral amyloid angiopathy (CAA) :
micro hemorrhage
• Cerebral venous thrombosis
Imaging Modalities
• CT
• MRI
MRA (MR arteriography) can be done with & without contarst
• Angiography
CT
• CT scan is almost always the
(1
st
)
imaging
modality used to assess patients with suspected
intracranial haemorrhage.
• Fortunately acute blood is markedly
hyperdense
compared to brain parenchyma
is increasingly used to
assess for a vascular underlying cause,
particularly in cases of subarachnoid
haemorrhage, or intra-parenchymal
haemorrhage
can be used to reliably
assess for patency of the dural venous sinuses.
MRI
• Excellent tissue characterization.
• The appearance of blood changes depending
on the sequence and the time.
• Hematoma aging is made by MRI
Intra axial
* Intra parenchymal *
Hematoma
Intra cerebral –
LT basal ganglia
hematoma
Large cerebella
haemorrhage
with intra
ventricular
extension
Intracerebral
haemorrhage
(warfarinised)
Extra axial
* Extra parenchymal *
Hematoma
Extra-axial Hematoma
Epidural vs Subdural
Epidural
Subdural
Vessel involved
Mostly: middle
meningeal artery
Bridging veins
Symptoms
Lucid interval
followed by
Unconsciousness
Gradually
increasing headache
&confusion
Location
Between the skull and
the outer endosteal
layer of the dura mater
Between the dura and
the arachnoid
Cross Midline
Yes
No
CT appearance
Biconvex lens
Crescent-shaped
Epi-dural Hematoma
Sub-dural Hematoma
Subarachnoid Hge