Intracranial hemorrhage

Colloquially, cerebral hemorrhage as an umbrella term for bleeding inside the skull ( intracranial) in the area of ​​the brain ( intracerebral ) or the meninges ( extracerebral ) to understand.

As a cerebral hemorrhage in the strict sense are only the intracerebral hemorrhage in the brain itself This usually occurs suddenly, especially in people with high blood pressure, and manifests itself as a stroke. In the broadest sense to include cerebral hemorrhage, the subarachnoid hemorrhage, Epiduralblutung and Subduralblutung that occur during traumatic brain injury or vascular abnormalities.

Intracranial bleeding may be life-threatening. Many patients with a cerebral hemorrhage must be treated neurosurgical.

The incidence of cerebral hemorrhage in Germany is between 10 and 12/100.000 inhabitants.

Causes

• Trauma
• Hypertension
• Vascular tumors
• Brain tumors
• Hirnaneurysmata
• Vasculitis
• Coagulopathy
• Treatment with anticoagulants ( Blutgerinngshemmern )
• Cerebral amyloid angiopathy
• Vascular malformations

If no cause can be demonstrated, it is called spontaneous cerebral hemorrhage.

Especially traumatic brain hemorrhages are frequently occurring in alcoholic patients, as they often suffer while drunk falls, where they bounce lack of protective reflexes with his head. In addition, people can with appropriate liver damage with alcohol dependence have an impaired blood clotting, which promotes bleeding events and complicated. Basal ganglia hemorrhage is a so-called Loco - Typico hemorrhage ( typical localization of the bleeding ); Vessels make a " kink".

Intracranial, intracerebral bleeding

Intracerebral hemorrhage is brain and resulting in an impairment of the cerebral function, for the affected brain tissue is required. Due to the size and location of the bleeding their room demanding behavior is determined. Feared is the brain hemorrhage, destroyed large parts of the brain and can lead to strangulation.

Intracranial, extracerebral bleeding

Epidural hematoma

An epidural hematoma occurs due to an intracranial hemorrhage into the epidural space between the skull bone and dura mater, triggered by trauma, usually with fracture of the skull.

Two forms with prognostically different disposition can be distinguished:

When arterial epidural hematoma inside the crack on the skull bones lying arterial vessels, particularly the middle meningeal artery. Typically followed by a symptom- poor or symptom-free interval (latency), but which can also completely missing, for minutes to hours. The bleeding progresses and increasingly presses the Dura Mater ( dura mater) and the brain inside. Nausea, vomiting, loss of consciousness and pupil dilation on the affected side are the consequences. There is danger to life. At the hospital, usually an emergency surgery is done with the opening of the skull ( trepanation ) or so -called Krönlein - hole (named after Rudolf Ulrich Krönlein ) behind and in front of the ear at the level of the eyebrows of the affected side to relieve the pressure. With timely treatment, the chances of survival are around 70 % (20% with disabilities).

In a venous fracture hematoma, however, oozes with a fracture of the skull bone, venous blood from the fracture line into the epidural space. The bleeding is when progressive, then slow and low.

Subduralblutung

As a subdural hematoma ( subdural hematoma, SDH ) is called a bruise ( hematoma ) under ( Lat. sub) of the tough meninges between the dura mater and the arachnoid. The acute subdural hematoma occurs with severe head injuries with concomitant to further damage. It must be relieved by opening the skull and ends without surgery usually fatal.

Chronic subdural hematoma is typically produced by slight craniocerebral trauma, by definition, after at least two weeks, although usually it should be investigated (in 50 percent of cases) in exploration no trauma. Old age and anticoagulation ( by drugs or alcoholic liver injury ) favor its formation. In older people, there is a physiological brain volume reduction and thus to a train to the bridging veins, which can then be damaged by slight trauma. The flow of blood through said bridging veins may be hampered by the subdural hematoma, so that it comes in addition to venous congestion of the brain part, on which lies the subdural hematoma. Headache, feeling of pressure, disorientation, impaired consciousness, but rarely paralysis may result. Also the chronic subdural hematoma is drained to the outside, here the prognosis is better than in acute.

Subarachnoid hemorrhage

The subarachnoid hemorrhage (SAH ) is - as the name says - under the arachnoid ( arachnoid ), the einkleidet the brain. This type of bleeding is arterial nature and has as a leading symptom is a sudden headache event ( destruction headache ) with nausea and vomiting.

To a subarachnoid hemorrhage may at a rupture of an aneurysm (arterial vessel wall deformity, which leads to a vessel outpocketing with poor muscle layer) of the arteries of the circle of Willis ( Willis ) or arising therefrom large arteries come. In a subarachnoid hemorrhage, in contrast to the two other types of bleeding, blood in the cerebrospinal fluid is detectable.