Advertisement

Vascular Disorders: Hemorrhage

  • Serge Weis
  • Michael Sonnberger
  • Andreas Dunzinger
  • Eva Voglmayr
  • Martin Aichholzer
  • Raimund Kleiser
  • Peter Strasser
Chapter
  • 386 Downloads

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).

Selected References

  1. Abraham MK, Chang WW (2016) Subarachnoid hemorrhage. Emerg Med Clin North Am 34(4):901–916.  https://doi.org/10.1016/j.emc.2016.06.011Google Scholar
  2. 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.2017.07.114Google Scholar
  3. 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.2016.11.009Google Scholar
  4. 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.2016.00864Google Scholar
  5. 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.0000080678.09344.8dGoogle Scholar
  6. Bauer AM, Rasmussen PA (2014) Treatment of intracranial vasospasm following subarachnoid hemorrhage. Front Neurol 5:72.  https://doi.org/10.3389/fneur.2014.00072Google Scholar
  7. 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.2016.05.084Google Scholar
  8. Chau M, Chen JC, Levy ML (2000) Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurg Clin N Am 11(3):399–406Google Scholar
  9. 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_7Google Scholar
  10. 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.2015.05.004Google Scholar
  11. Ciurea AV, Palade C, Voinescu D, Nica DA (2013) Subarachnoid hemorrhage and cerebral vasospasm - literature review. J Med Life 6(2):120–125Google Scholar
  12. 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.2015.11.015Google Scholar
  13. 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/s12028-013-9884-4Google Scholar
  14. Domenicucci M, Signorini P, Strzelecki J, Delfini R (1995) Delayed post-traumatic epidural hematoma. A review. Neurosurg Rev 18(2):109–122Google Scholar
  15. Dority JS, Oldham JS (2016) Subarachnoid hemorrhage: an update. Anesthesiol Clin 34(3):577–600.  https://doi.org/10.1016/j.anclin.2016.04.009Google Scholar
  16. 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.115.011386Google Scholar
  17. 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/s11910-014-0521-1Google Scholar
  18. 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.2015.06.003Google Scholar
  19. 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/s12028-015-0183-0Google Scholar
  20. 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.2015.04.003Google Scholar
  21. Figueroa J, DeVine JG (2017) Spontaneous spinal epidural hematoma: literature review. J Spine Surg 3(1):58–63.  https://doi.org/10.21037/jss.2017.02.04Google Scholar
  22. 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.113.002533Google Scholar
  23. Francoeur CL, Mayer SA (2016) Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care 20(1):277.  https://doi.org/10.1186/s13054-016-1447-6Google Scholar
  24. Gulati D, Dua D, Torbey MT (2017) Hemostasis in intracranial hemorrhage. Front Neurol 8:80.  https://doi.org/10.3389/fneur.2017.00080Google Scholar
  25. Hayakawa M (2015) Reperfusion-related Intracerebral hemorrhage. Front Neurol Neurosci 37:62–77.  https://doi.org/10.1159/000437114Google Scholar
  26. 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
  27. Heit JJ, Iv M, Wintermark M (2017) Imaging of intracranial hemorrhage. J Stroke 19(1):11–27.  https://doi.org/10.5853/jos.2016.00563Google Scholar
  28. 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 924-929Google Scholar
  29. 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.2014.881418Google Scholar
  30. 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.2015.08.052Google Scholar
  31. 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/s11940-016-0421-6Google Scholar
  32. 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):887–894Google Scholar
  33. Killeffer JA, Killeffer FA, Schochet SS (2000) The outer neomembrane of chronic subdural hematoma. Neurosurg Clin N Am 11(3):407–412Google Scholar
  34. 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.111.000773Google Scholar
  35. Lawton MT, Vates GE (2017) Subarachnoid hemorrhage. N Engl J Med 377(3):257–266.  https://doi.org/10.1056/NEJMcp1605827Google Scholar
  36. 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.0152568Google Scholar
  37. 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/10.4103/0028-3886.93581Google Scholar
  38. 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.jns132715Google Scholar
  39. Macellari F, Paciaroni M, Agnelli G, Caso V (2014) Neuroimaging in intracerebral hemorrhage. Stroke 45(3):903–908.  https://doi.org/10.1161/strokeaha.113.003701Google Scholar
  40. 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-zGoogle Scholar
  41. 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.12.9749Google Scholar
  42. 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.117.017282Google Scholar
  43. 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/10.1155/2014/384342Google Scholar
  44. 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.2016.00210Google Scholar
  45. 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.2016.06.010Google Scholar
  46. 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.0000000000000222Google Scholar
  47. Öhmichen M, Auer R, König H (2006) Forensic neuropathology and associated neurology. Springer, BerlinGoogle Scholar
  48. 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):1770–1783Google Scholar
  49. 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.112.655910Google Scholar
  50. 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):392–402Google Scholar
  51. 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.2017.05.030Google Scholar
  52. 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/s12975-015-0410-1Google Scholar
  53. 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.2014.03.015Google Scholar
  54. 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/s00381-012-1870-1Google Scholar
  55. 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.0000000163Google Scholar
  56. Stoodley M, Weir B (2000) Contents of chronic subdural hematoma. Neurosurg Clin N Am 11(3):425–434Google Scholar
  57. Suarez JI (2015) Diagnosis and management of subarachnoid hemorrhage. Continuum (Minneap, Minn) 21(5 Neurocritical Care):1263–1287.  https://doi.org/10.1212/con.0000000000000217Google Scholar
  58. Tanaka Y, Ohno K (2013) Chronic subdural hematoma—an up-to-date concept. J Med Dent Sci 60(2):55–61Google Scholar
  59. Thabet AM, Kottapally M, Hemphill JC 3rd (2017) Management of intracerebral hemorrhage. Handb Clin Neurol 140:177–194.  https://doi.org/10.1016/b978-0-444-63600-3.00011-8Google Scholar
  60. 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-yGoogle Scholar
  61. 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.2016.11.007Google Scholar
  62. Wilberger JE (2000) Pathophysiology of evolution and recurrence of chronic subdural hematoma. Neurosurg Clin N Am 11(3):435–438Google Scholar
  63. Williams VL, Hogg JP (2000) Magnetic resonance imaging of chronic subdural hematoma. Neurosurg Clin N Am 11(3):491–498Google Scholar
  64. Wilson CD, Shankar JJ (2014) Diagnosing vasospasm after subarachnoid hemorrhage: CTA and CTP. Can J Neurol Sci 41(3):314–319Google Scholar
  65. Yadav YR, Parihar V, Namdev H, Bajaj J (2016) Chronic subdural hematoma. Asian J Neurosurg 11(4):330–342.  https://doi.org/10.4103/1793-5482.145102Google Scholar
  66. 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.2016.11.002Google Scholar
  67. 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.2017.02.001Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Serge Weis
    • 1
  • Michael Sonnberger
    • 2
  • Andreas Dunzinger
    • 3
  • Eva Voglmayr
    • 2
  • Martin Aichholzer
    • 4
  • Raimund Kleiser
    • 2
  • Peter Strasser
    • 5
  1. 1.Division of Neuropathology, Neuromed CampusKepler University Hospital, Johannes Kepler UniversityLinzAustria
  2. 2.Department of Neuroradiology, Neuromed CampusKepler University Hospital, Johannes Kepler UniversityLinzAustria
  3. 3.Department of Neuro-Nuclear Medicine, Neuromed CampusKepler University Hospital, Johannes Kepler UniversityLinzAustria
  4. 4.Department of Neurosurgery, Neuromed CampusKepler University Hospital, Johannes Kepler UniversityLinzAustria
  5. 5.PMU University Institute for Medical & Chemical Laboratory DiagnosticsSalzburgAustria

Personalised recommendations