Vascular Disorders: Hemorrhage
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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).
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