Abstract
Various types of hemorrhages are distinguished including subcutaneous, subgaleal, epidural, subdural, subarachnoid, intracerebral, intramedullary, choroid plexus, and germinal matrix hemorrhage. Clinical characterization of hematomas is based on time elapsed after the causing event: hyperacute, acute (6 h to 3 days), early subacute, late subacute, and chronic.
The pathogenesis varies between the different types of hemorrhages. Subdural hemorrhage (primarily due to arterial hypertension, cerebral amyloid angiopathy, secondarily due to trauma, arteriovenous malformations, brain tumors), subarachnoid hemorrhage (ruptured saccular aneurysm in 85% of cases, non-inflammatory lesions of intracerebral vessels, i.e., arterial dissection and cerebral arteriovenous malformation, inflammatory lesions of cerebral arteries like mycotic aneurysm), subdural hemorrhage (traumatic brain injuries, rupture of a bridging vein, coagulopathy, or medical anticoagulation), epidural hemorrhage (trauma).
Equally, treatment varies between the different types of hemorrhages. Subdural hemorrhage (surgical evacuation of supratentorial intracerebral hemorrhage in selected patients, hemostatic drug therapy, and blood pressure reduction), subarachnoid hemorrhage (calcium antagonist Nimodipine, endovascular coiling/neurosurgical clipping of aneurysm), subdural hemorrhage (surgical removal of hemorrhage, might regress spontaneously), epidural hemorrhage (craniotomy).
The clinical outcome also varies between the different types of hemorrhages. Subdural hemorrhage (lethal to good outcome), subarachnoid hemorrhage (management of modifiable factors), subdural hemorrhage (age of patient, acute versus chronic subdural hematoma), and epidural hemorrhage (timely diagnosis and treatment, clinical deterioration).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Selected References
Abraham MK, Chang WW (2016) Subarachnoid hemorrhage. Emerg Med Clin North Am 34(4):901–916. https://doi.org/10.1016/j.emc.2016.06.011
Al-Mufti F, Amuluru K, Smith B, Damodara N, El-Ghanem M, Singh IP, Dangayach N, Gandhi CD (2017) Early emerging markers of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage: a literature review. World Neurosurg 107:148–159. https://doi.org/10.1016/j.wneu.2017.07.114
Al-Mufti F, Mayer SA (2017) Neurocritical care of acute subdural hemorrhage. Neurosurg Clin N Am 28(2):267–278. https://doi.org/10.1016/j.nec.2016.11.009
An SJ, Kim TJ, Yoon BW (2017) Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update. J Stroke 19(1):3–10. https://doi.org/10.5853/jos.2016.00864
Ariesen MJ, Claus SP, Rinkel GJ, Algra A (2003) Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 34(8):2060–2065. https://doi.org/10.1161/01.str.0000080678.09344.8d
Bauer AM, Rasmussen PA (2014) Treatment of intracranial vasospasm following subarachnoid hemorrhage. Front Neurol 5:72. https://doi.org/10.3389/fneur.2014.00072
Catana D, Koziarz A, Cenic A, Nath S, Singh S, Almenawer SA, Kachur E (2016) Subdural hematoma mimickers: a systematic review. World Neurosurg 93:73–80. https://doi.org/10.1016/j.wneu.2016.05.084
Chau M, Chen JC, Levy ML (2000) Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurg Clin N Am 11(3):399–406
Chen S, Wu H, Tang J, Zhang J, Zhang JH (2015a) Neurovascular events after subarachnoid hemorrhage: focusing on subcellular organelles. Acta Neurochir Suppl 120:39–46. https://doi.org/10.1007/978-3-319-04981-6_7
Chen Y, Li Q, Tang J, Feng H, Zhang JH (2015b) The evolving roles of pericyte in early brain injury after subarachnoid hemorrhage. Brain Res 1623:110–122. https://doi.org/10.1016/j.brainres.2015.05.004
Ciurea AV, Palade C, Voinescu D, Nica DA (2013) Subarachnoid hemorrhage and cerebral vasospasm - literature review. J Med Life 6(2):120–125
Dabdoub CB, Adorno JO, Urbano J, Silveira EN, Orlandi BM (2016) Review of the management of infected subdural hematoma. World Neurosurg 87:663.e661–663.e668. https://doi.org/10.1016/j.wneu.2015.11.015
de Lima Oliveira M, Kairalla AC, Fonoff ET, Martinez RC, Teixeira MJ, Bor-Seng-Shu E (2014) Cerebral microdialysis in traumatic brain injury and subarachnoid hemorrhage: state of the art. Neurocrit Care 21(1):152–162. https://doi.org/10.1007/s12028-013-9884-4
Domenicucci M, Signorini P, Strzelecki J, Delfini R (1995) Delayed post-traumatic epidural hematoma. A review. Neurosurg Rev 18(2):109–122
Dority JS, Oldham JS (2016) Subarachnoid hemorrhage: an update. Anesthesiol Clin 34(3):577–600. https://doi.org/10.1016/j.anclin.2016.04.009
Dubosh NM, Bellolio MF, Rabinstein AA, Edlow JA (2016) Sensitivity of early brain computed tomography to exclude aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Stroke 47(3):750–755. https://doi.org/10.1161/strokeaha.115.011386
Durrant JC, Hinson HE (2015) Rescue therapy for refractory vasospasm after subarachnoid hemorrhage. Curr Neurol Neurosci Rep 15(2):521. https://doi.org/10.1007/s11910-014-0521-1
Edjlali M, Rodriguez-Regent C, Hodel J, Aboukais R, Trystram D, Pruvo JP, Meder JF, Oppenheim C, Lejeune JP, Leclerc X, Naggara O (2015) Subarachnoid hemorrhage in ten questions. Diagn Interv Imaging 96(7-8):657–666. https://doi.org/10.1016/j.diii.2015.06.003
Edlow JA, Figaji A, Samuels O (2015) Emergency neurological life support: subarachnoid hemorrhage. Neurocrit Care 23(suppl 2):S103–S109. https://doi.org/10.1007/s12028-015-0183-0
Egashira Y, Hua Y, Keep RF, Xi G (2015) Intercellular cross-talk in intracerebral hemorrhage. Brain Res 1623:97–109. https://doi.org/10.1016/j.brainres.2015.04.003
Figueroa J, DeVine JG (2017) Spontaneous spinal epidural hematoma: literature review. J Spine Surg 3(1):58–63. https://doi.org/10.21037/jss.2017.02.04
Flaherty ML, Beck J (2013) Surgery for intracerebral hemorrhage: moving forward or making circles? Stroke 44(10):2953–2954. https://doi.org/10.1161/strokeaha.113.002533
Francoeur CL, Mayer SA (2016) Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care 20(1):277. https://doi.org/10.1186/s13054-016-1447-6
Gulati D, Dua D, Torbey MT (2017) Hemostasis in intracranial hemorrhage. Front Neurol 8:80. https://doi.org/10.3389/fneur.2017.00080
Hayakawa M (2015) Reperfusion-related Intracerebral hemorrhage. Front Neurol Neurosci 37:62–77. https://doi.org/10.1159/000437114
Hayman EG, Patel AP, James RF, Simard JM (2017) Heparin and heparin-derivatives in post-subarachnoid hemorrhage brain injury: a multimodal therapy for a multimodal disease. Molecules 22(5). https://doi.org/10.3390/molecules22050724
Heit JJ, Iv M, Wintermark M (2017) Imaging of intracranial hemorrhage. J Stroke 19(1):11–27. https://doi.org/10.5853/jos.2016.00563
Heyman R, Heckly A, Magagi J, Pladys P, Hamlat A (2005) Intracranial epidural hematoma in newborn infants: clinical study of 15 cases. Neurosurgery 57(5):924–929;discussion 924-929
Hong CM, Tosun C, Kurland DB, Gerzanich V, Schreibman D, Simard JM (2014) Biomarkers as outcome predictors in subarachnoid hemorrhage–a systematic review. Biomarkers 19(2):95–108. https://doi.org/10.3109/1354750x.2014.881418
Inagawa T (2016) Risk factors for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a review of the literature. World Neurosurg 85:56–76. https://doi.org/10.1016/j.wneu.2015.08.052
James RF, Kramer DR, Aljuboori ZS, Parikh G, Adams SW, Eaton JC, Abou Al-Shaar H, Badjatia N, Mack WJ, Simard JM (2016) Novel treatments in neuroprotection for aneurysmal subarachnoid hemorrhage. Curr Treat Options Neurol 18(8):38. https://doi.org/10.1007/s11940-016-0421-6
Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T (2014) Surgical management of traumatic acute subdural hematoma in adults: a review. Neurol Med Chir 54(11):887–894
Killeffer JA, Killeffer FA, Schochet SS (2000) The outer neomembrane of chronic subdural hematoma. Neurosurg Clin N Am 11(3):407–412
Koch S, Gonzalez N (2013) Preconditioning the human brain: proving the principle in subarachnoid hemorrhage. Stroke 44(6):1748–1753. https://doi.org/10.1161/strokeaha.111.000773
Lawton MT, Vates GE (2017) Subarachnoid hemorrhage. N Engl J Med 377(3):257–266. https://doi.org/10.1056/NEJMcp1605827
Lindbohm JV, Kaprio J, Korja M (2016) Cholesterol as a risk factor for subarachnoid hemorrhage: a systematic review. PLoS One 11(4):e0152568. https://doi.org/10.1371/journal.pone.0152568
Liu B, Zhang L, Yang Q (2012) Genetics of intracerebral hemorrhage: insights from candidate gene approaches. Neurol India 60(1):3–8. https://doi.org/10.4103/0028-3886.93581
Liu W, Bakker NA, Groen RJ (2014) Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg 121(3):665–673. https://doi.org/10.3171/2014.5.jns132715
Macellari F, Paciaroni M, Agnelli G, Caso V (2014) Neuroimaging in intracerebral hemorrhage. Stroke 45(3):903–908. https://doi.org/10.1161/strokeaha.113.003701
Mangla R, Drumsta D, Alamst J, Mangla M, Potchen M (2015) Cerebral convexity subarachnoid hemorrhage: various causes and role of diagnostic imaging. Biomed Res Int 22(2):181–195. https://doi.org/10.1007/s10140-014-1251-z
Marder CP, Narla V, Fink JR, Tozer Fink KR (2014) Subarachnoid hemorrhage: beyond aneurysms. AJR Am J Roentgenol 202(1):25–37. https://doi.org/10.2214/ajr.12.9749
Milinis K, Thapar A, O’Neill K, Davies AH (2017) History of aneurysmal spontaneous subarachnoid hemorrhage. Stroke 48(10):e280–e283. https://doi.org/10.1161/strokeaha.117.017282
Miller BA, Turan N, Chau M, Pradilla G (2014) Inflammation, vasospasm, and brain injury after subarachnoid hemorrhage. Biomed Res Int 2014:384342. https://doi.org/10.1155/2014/384342
Mittal MK, LacKamp A (2016) Intracerebral hemorrhage: perihemorrhagic edema and secondary hematoma expansion: from bench work to ongoing controversies. Front Neurol 7:210. https://doi.org/10.3389/fneur.2016.00210
Morotti A, Goldstein JN (2016) Diagnosis and management of acute intracerebral hemorrhage. Emerg Med Clin North Am 34(4):883–899. https://doi.org/10.1016/j.emc.2016.06.010
Naidech AM (2015) Diagnosis and management of spontaneous intracerebral hemorrhage. Continuum (Minneap, Minn) 21(5 Neurocritical Care):1288–1298. https://doi.org/10.1212/con.0000000000000222
Öhmichen M, Auer R, König H (2006) Forensic neuropathology and associated neurology. Springer, Berlin
Parizel PM, Makkat S, Van Miert E, Van Goethem JW, van den Hauwe L, De Schepper AM (2001) Intracranial hemorrhage: principles of CT and MRI interpretation. Eur Radiol 11(9):1770–1783
Prabhakaran S, Naidech AM (2012) Ischemic brain injury after intracerebral hemorrhage: a critical review. Stroke 43(8):2258–2263. https://doi.org/10.1161/strokeaha.112.655910
Pradilla G, Righy C, Bozza MT, Oliveira MF, Bozza FA (2016) Molecular, cellular and clinical aspects of intracerebral hemorrhage: are the enemies within? Curr Neuropharmacol 14(4):392–402
Sahyouni R, Mahboubi H, Tran P, Roufail JS, Chen JW (2017) Membranectomy in chronic subdural hematoma: meta-analysis. World Neurosurg 104:418–429. https://doi.org/10.1016/j.wneu.2017.05.030
Schlunk F, Greenberg SM (2015) The pathophysiology of intracerebral hemorrhage formation and expansion. Transl Stroke Res 6(4):257–263. https://doi.org/10.1007/s12975-015-0410-1
Sieswerda-Hoogendoorn T, Postema FAM, Verbaan D, Majoie CB, van Rijn RR (2014) Age determination of subdural hematomas with CT and MRI: a systematic review. Eur J Radiol 83(7):1257–1268. https://doi.org/10.1016/j.ejrad.2014.03.015
Squier W, Mack J, Green A, Aziz T (2012) The pathophysiology of brain swelling associated with subdural hemorrhage: the role of the trigeminovascular system. Childs Nerv Syst 28(12):2005–2015. https://doi.org/10.1007/s00381-012-1870-1
Stippler M, Ramirez P, Berti A, Macindoe C, Villalobos N, Murray-Krezan C (2013) Chronic subdural hematoma patients aged 90 years and older. Neurol Res 35(3):243–246. https://doi.org/10.1179/1743132813y.0000000163
Stoodley M, Weir B (2000) Contents of chronic subdural hematoma. Neurosurg Clin N Am 11(3):425–434
Suarez JI (2015) Diagnosis and management of subarachnoid hemorrhage. Continuum (Minneap, Minn) 21(5 Neurocritical Care):1263–1287. https://doi.org/10.1212/con.0000000000000217
Tanaka Y, Ohno K (2013) Chronic subdural hematoma—an up-to-date concept. J Med Dent Sci 60(2):55–61
Thabet AM, Kottapally M, Hemphill JC 3rd (2017) Management of intracerebral hemorrhage. Handb Clin Neurol 140:177–194. https://doi.org/10.1016/b978-0-444-63600-3.00011-8
van Lieshout JH, Dibue-Adjei M, Cornelius JF, Slotty PJ, Schneider T, Restin T, Boogaarts HD, Steiger HJ, Petridis AK, Kamp MA (2018) An introduction to the pathophysiology of aneurysmal subarachnoid hemorrhage. Neurosurg Rev 41(4):917–930. https://doi.org/10.1007/s10143-017-0827-y
Vega RA, Valadka AB (2017) Natural history of acute subdural hematoma. Neurosurg Clin N Am 28(2):247–255. https://doi.org/10.1016/j.nec.2016.11.007
Wilberger JE (2000) Pathophysiology of evolution and recurrence of chronic subdural hematoma. Neurosurg Clin N Am 11(3):435–438
Williams VL, Hogg JP (2000) Magnetic resonance imaging of chronic subdural hematoma. Neurosurg Clin N Am 11(3):491–498
Wilson CD, Shankar JJ (2014) Diagnosing vasospasm after subarachnoid hemorrhage: CTA and CTP. Can J Neurol Sci 41(3):314–319
Yadav YR, Parihar V, Namdev H, Bajaj J (2016) Chronic subdural hematoma. Asian J Neurosurg 11(4):330–342. https://doi.org/10.4103/1793-5482.145102
Yang W, Huang J (2017) Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am 28(2):205–210. https://doi.org/10.1016/j.nec.2016.11.002
Zheng VZ, Wong GKC (2017) Neuroinflammation responses after subarachnoid hemorrhage: a review. J Clin Neurosci 42:7–11. https://doi.org/10.1016/j.jocn.2017.02.001
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer-Verlag GmbH Austria, part of Springer Nature
About this chapter
Cite this chapter
Weis, S. et al. (2019). Vascular Disorders: Hemorrhage. In: Imaging Brain Diseases. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1544-2_19
Download citation
DOI: https://doi.org/10.1007/978-3-7091-1544-2_19
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-1543-5
Online ISBN: 978-3-7091-1544-2
eBook Packages: MedicineMedicine (R0)