Intracranial Hemorrhage- Epidural/Subdural/Subarachnoid overview
What are intracranial hemorrhage, cerebral hemorrhage, and hemorrhagic stroke?
An intracranial hemorrhage is a type of bleeding that occurs inside the skull (cranium).
Intracranial hemorrhage basically means hemorrhage within the cranium or skull. It is a broad term because hemorrhage can occur in different region within the skull.
Broadly we can divide it into extra-axial hemorrhage and intra-axial hemorrhage.
Extra axial- when bleeding occurs within the skull but outside the brain tissue
Intra-axial- when bleeding occurs within the brain tissue..
Extra-axial hemorrhage are of 3 types
1) epidural
2) subdural
3) sub arachnoid
Intra-axial hemorrhage are of 2 types
1) intracerebral
2) intraventricular
Bleeding caused by a blood vessel in the brain that has leaked or ruptured (torn) is called a hemorrhagic stroke. (All bleeding within the skull is referred to as intracranial hemorrhage.)
Hemorrhages that occur within the skull or brain generally happen suddenly, from either external or internal causes. A hemorrhage can rapidly cause brain damage and can be life-threatening.
Since the brain cannot store oxygen, it relies upon a series of blood vessels to supply oxygen and nutrients. When a hemorrhage occurs, oxygen may no longer be able to reach brain tissue supplied by leaky or broken blood vessels. Pooling of blood from an intracranial hemorrhage or cerebral hemorrhage also puts pressure on the brain and deprives it of oxygen.
When a hemorrhage or stroke interrupts blood flow around or inside the brain, depriving it of oxygen for more than three or four minutes, the brain cells die. The affected nerve cells and the related functions they control are damaged as well.
Who is affected by intracranial hemorrhage?
Stroke is the leading cause of disability and the fifth-leading cause of death in the United States. Intracranial hemorrhage accounts for approximately 10% of all strokes in the U.S.
Intracranial hemorrhage can strike people of any age, depending upon the cause. Although cerebral hemorrhage and hemorrhagic stroke are most commonly associated with older adults, they can also occur in children (pediatric stroke).
What are the causes of intracranial hemorrhage?
Intracranial hemorrhage has a number of causes, including:
Head trauma, such as that caused by a fall, car accident, sports accident, etc.
Hypertensive (high blood pressure) damage to blood vessel walls that causes the blood vessel to leak or break
Blockage of an artery in the brain by a blood clot that formed in the brain or traveled to the brain from another part of the body, with subsequent leakage from the damaged artery
Ruptured cerebral aneurysm (a weak spot in a blood vessel wall that balloons out and bursts)
Buildup of amyloid protein within the artery walls of the brain (cerebral amyloid angiopathy)
Leaking of malformed arteries or veins (arteriovenous malformation)
Treatment with anticoagulant therapy (blood thinners)
Bleeding tumors
Smoking, excessive alcohol use, or use of illegal drugs such as cocaine
Conditions related to pregnancy or childbirth, including eclampsia, postpartum vas culopathy, or neonatal intraventricular hemorrhage
What are the symptoms of intracranial hemorrhage?
Sudden tingling, weakness, numbness, or paralysis of the face, arm or leg, particularly on one side of the body
Sudden, severe headache
Difficulty with swallowing or vision
Loss of balance or coordination
Difficulty understanding, speaking (slurring nonsensical speech), reading, or writing
Change in level of consciousness or alertness, marked by stupor, lethargy, sleepiness, or coma
What are the effects of intracranial hemorrhage?
Besides depriving the brain of oxygen and killing brain cells, bleeding inside the brain also prevents nerve cells from communicating with the parts of the body and the functions they control. This results in a loss of memory, speech, or movement in the affected area.
Depending on the location of the hemorrhage and the extent of damage, the lasting effects of the intracranial hemorrhage can include:
Inability to move part of the body (paralysis)
Numbness or weakness in part of the body
Difficulty swallowing
Vision loss
Inability to speak or understand words (difficulty with communicating or comprehension)
Confusion, memory loss, or poor judgment
Personality change and/or emotional problems
How is intracranial hemorrhage diagnosed?
Diagnosis generally includes:
Evaluation of physical symptoms
A CT scan of the brain to determine if bleeding is present
An MRI to more clearly reveal the cause of bleeding
Other tests may include:
Electrocardiogram, chest X-ray, and/or urinalysis
Complete vascular study, complete blood count (CBC), and/or blood studies
Cerebrospinal fluid exam
In some cases, conventional angiography may be done to identify an aneurysm or arteriovenous malformation (irregularly formed arteries or veins)