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Other causes of intracerebral hemorrhage

Intracerebral hemorrhage after head injury (traumatic brain injury)

Head injury may cause intracerebral hematoma and hematoma, beneath the snaring of the cerebellum (subtentorial), subarachnoid hemorrhage, acute and chronic subdural hematoma and acute epidural hematoma. Intracerebral hematoma in patients with traumatic brain injury most often formed in the temporal lobe and in the lower regions of the frontal lobe of the brain. This should be remembered in all cases where the patient has an acute neurological deficit of unknown origin (hemiparesis, stupor or disorientation), especially if the condition is similar to a stroke occurred after a fall.

For suspected hemorrhage after head injury pacient need to perform magnetic resonance (MRI) or computerized (CT) imaging of the brain. In addition to the survey scan a patient with intracranial hemorrhage, it may require additional treatment with an angiography. Surgical intervention often can save the life of such patients, so the diagnosis of intracerebral hemorrhage should not be missed.

Severe head injury leads to rupture of intracranial vessels and veins of the cerebral cortex with the formation of a hematoma.

Intracerebral hemorrhage associated with coagulopathy and hematopoietic disorders

Intracerebral hemorrhage can occur in patients with blood diseases. By the same blood diseases include leukemia, aplastic anemia, and thrombocytopenic purpura. Hematoma with blood disorders may be of any intracranial location and appear as multiple intracerebral hemorrhage. Typically, these patients hemorrhage visible as the skin and mucous membranes and is a diagnostic criterion. Intracerebral hemorrhage during treatment with anticoagulants may be of any intracerebral localization and evolve slowly - for 24-48 h.

Patients with blood diseases, complicated by intracerebral hemorrhage, emergency appointment shows transfusion of fresh frozen plasma. If the bleeding in the brain in a patient against a background of aspirin, we recommend to stop bleeding fresh infusion of platelets.

When diseases of the blood of intracerebral hematoma and subarachnoid hemorrhage may have any intracranial localization.

 

Hemorrhage into a brain tumor

Bleeding into the brain tumor may be the first manifestation of intracerebral tumors in a patient. The most common secondary tumors are formed in the brain and are accompanied by intracerebral hemorrhage, tumor cell metastasis include choriocarcinoma, malignant melanoma, renal and bronchogenic carcinoma. Such a brain tumor as a glioblastoma multiforme in adults and medulloblastoma in children are the most common primary intracerebral tumors, causing intracerebral hemorrhage patients.

Brain tumors (pituitary makroadenoma, arrow on the right) may be accompanied by intracerebral hemorrhage (two arrows on the left).

 

Other causes of intracerebral and spinal hemorrhage

Sometimes in patients are detected cerebral hemorrhages of unknown origin. Most often they occur in small angioma (hemangioma, arteriovenous malformations), and vascular disease such as amyloid angiopathy. Primary intraventricular hemorrhage in patients are rare. They are often secondary to bleeding that begins in the brain tissue (parenchymal hemorrhage), and only then penetrating into the ventricular system immediately, without giving the neurological symptoms characteristic of parenchymal hemorrhage.

Hemorrhagic encephalitis accompanied by small punctate hemorrhages (petechial hemorrhages ) in the white matter of the brain. With this type of hemorrhage of blood traces in the analysis of the cerebrospinal fluid did not show. Such small petechial hemorrhages (petechial hemorrhages) should not be confused with stroke. The reason for this type of hemorrhage, as a rule, against gram-negative sepsis bacterial infection.

Magnetic resonance imaging of the brain (MRI) reveals arteriovenous malformations before rupture (white arrow).

When encephalitis caused by herpes simplex virus (viral encephalitis), the analysis of cerebrospinal fluid (CSF, cerebrospinal fluid ) can be found erythrocytes.

Bleeding in the brain stem herniation noted at mechanical temporal lobes, accompanied by twisting of the brain stem. These hemorrhages occur when the patient is already comatose, so do not show neurological clinic of a stroke.

Inflammation of the arteries and veins, especially periarteritis nodosa and systemic lupus erythematosus, sometimes leading to bleeding in the central nervous system. Most often, these conditions are combined with hypertension in a patient.

There are other types of hemorrhages. Bleeding into the spinal cord is usually the result of an arteriovenous malformation (AVM, angioma, hemangioma), or metastatic tumor. Epidural spinal haemorrhage usually leads to a rapid compression of the spinal cord and must be recognized by a doctor immediately, because surgical intervention determine the effectiveness of treatment and prevents the development of paralysis of the muscles of the lower limbs (paraplegia).

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