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13 - Intracranial Hemorrhage

from Section 3 - Neurological Emergencies

Published online by Cambridge University Press:  02 November 2023

Kaushal Shah
Affiliation:
Weill Cornell Medical Center, New York
Jarone Lee
Affiliation:
Massachusetts General Hospital, Boston
Clark G. Owyang
Affiliation:
Weill Cornell Medical Center, New York
Benjamin Christian Renne
Affiliation:
Massachusetts General Hospital, Boston
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Summary

  • Intracranial hemorrhage (ICH) occurs when blood occupies space within the calvarium. ICH irritates brain parenchyma and impairs outflow of cerebral spinal fluid (CSF) from the dural sinus venous network, which raises intracranial pressure (ICP) with a resultant decrease in cerebral perfusion.

  • ICH types are defined by the location of the bleeding: intracerebral (within the parenchyma), epidural (between the skull and the dura), subdural (between the dura and arachnoid membrane) and subarachnoid (between arachnoid membrane and pia mater).

  • The skull is inelastic, so blood accumulation increases intracranial pressure.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2023

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References

Carney, N, Totten, AM, O’Reilly, C, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery 2017;80(1):615.CrossRefGoogle ScholarPubMed
Gross, BA, Jankowitz, BT, Friedlander, RM. Cerebral intraparenchymal hemorrhage: a review. JAMA 2019;321(13):12951303.CrossRefGoogle ScholarPubMed
Hemphill, JC 3rd, Greenberg, SM, Anderson, CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46:20322060.CrossRefGoogle ScholarPubMed
Marcolini, E, Stretz, C, DeWitt, KM. Intracranial hemorrhage and intracranial hypertension. Emerg Med Clin 2019;37(3):529544.CrossRefGoogle ScholarPubMed
Qureshi, AI, Huang, W, Lobanova, I, et al. Outcomes of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage and excessively high initial systolic blood pressure: post hoc analysis of a randomized clinical trial. JAMA Neurology 2020;77(11):13551365.CrossRefGoogle ScholarPubMed

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