7. A. Anterior Cerebral Artery
B. Middle Cerebral Artery
C. Post. Cerebral Artery
CTA Brain Maximum Intensity Projection
8. Intracranial Hemorrhage
• As an imaging technologist in advanced
imaging modalities, it is important to
understand the differences, and recognize the
physical appearance of different classifications
of intracranial hemorrhage.
• The following slides will help you recognize
and identify different types of intracranial
hemorrhage.
9. Types of Intracranial Hemorrhage
Intra-axial Extra-axial
• intraparenchymal • Epidural
– Bleeding within the brain – Bleeding that occurs between the
dura and cranial bone.
tissue.
• Subdural
• Intraventricular – Subdural hematoma occurs when
– Bleeding into the ventricles there is tearing of the bridging vein
between the cerebral cortex and a
draining venous sinus. At times
they may be caused by arterial
lacerations on the brain surface.
• Subarachnoid
– meningeal layers.occuring between
the arachnoid and pia
10. Intra-axial
• intraparenchymal • Intraventricular
– Intraventricular hemorrhage has
– Nontraumatic intraparenchymal hemorrhage been found to occur in 35% of
most commonly results from hypertensive moderate to severe traumatic brain
damage to blood vessel walls e.g.: - injuries.[11] The injury requires a
hypertension -eclampsia - drug abuse, but it
also may be due great deal of force to cause. Thus the
to autoregulatory dysfunction with excessive hemorrhage usually does not occur
cerebral blood flow e.g.: - reperfusion injury - without extensive associated
hemorrhagic transformation - cold exposure - damage, and so the outcome is rarely
rupture of an aneurysm or arteriovenous
malformation (AVM) - arteriopathy good.[12][13]
(e.g. cerebral amyloid angiopathy, moyamoya) – Prognosis is also dismal when IVH
- results from intracerebral
altered hemostasis (e.g. thrombolysis, anticoa
gulation, bleeding diathesis) - hemorrhagic hemorrhage related to high blood
necrosis (e.g.tumor, infection) - venous pressure and is even worse
outflow obstruction (e.g. cerebral venous when hydrocephalus follows.[1] It
sinus thrombosis). Nonpenetrating and can result in dangerous increases
penetrating cranial trauma can be also
common causes of intracerebral hemorrhage. in intracranial pressure and can cause
potentially fatal brain herniation.[1]
11. Extra-Axial
• Epidural Hematoma
– Bleeding between the dura of the brain and the
inner surface of the cranium.
• This is a traumatic injury caused by a sharp blow to the
head. Often this type of hemorrhage will be associated
with an underlying cranial fracture.
12. Extra-Axial
• Subdural Hematoma
• Subdural hematomas are usually the result of a serious head injury.
When one occurs in this way, it is called an "acute" subdural
hematoma. Acute subdural hematomas are among the deadliest of
all head injuries. The bleeding fills the brain area very
rapidly, compressing brain tissue. This often results in brain injury
and may lead to death.
• Subdural hematomas can also occur after a very minor head
injury, especially in the elderly. These may go unnoticed for many
days to weeks, and are called "chronic" subdural hematomas. With
any subdural hematoma, tiny veins between the surface of the
brain and its outer covering (the dura) stretch and tear, allowing
blood to collect. In the elderly, the veins are often already stretched
because of brain atrophy (shrinkage) and are more easily injured.
15. Epidural Hemorrhage
Note convex appearance of hemorrhage
This is caused by the pressure of the blood
Pushing against the dural membrane
16. Subdural Hemorrhage
Concave, “quarter moon” appearance
suggesting separation of the surface
of the brain from the dura.. Also,
note the appearance of blood in the
sagittal sinus.
17. Subarachnoid Hemorrhage
The presence of blood within the
Sylvian (lateral) fissures is a clear
indication of SAH.
18. Last Slide
Keep up the good work!
All material in this presentation is testable.
