Transcript Intracranial Hemorrhage

Nikdokht Farid, M.D.
Assistant Professor
UCSD Department of Radiology
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Patchy multifocal superficial hemorrhages
surrounded by edema
Anterior inferior frontal and temporal lobes are
most common site (“frontal and temporal poles”)
Coup and contracoup injury sites
Often associated with subdural hematoma (SDH),
traumatic subarachnoid hemorrhage (SAH),
intraventricular hemorrhage (IVH)
“Blossoming” of contusions may occur (ongoing
hemorrhage or worsening edema)
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Biconvex or lentiform extra-axial collection—
usually hyperdense (low density “swirl sign”)
Does not cross suture lines
90% arterial, 10% venous
Arterial EDH often associated with fracture
near middle meningeal artery groove
Venous EDH often associated with fracture
near dural sinus attachment
Mass effect on underlying brain and
subarachnoid space
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Crescentic extra-axial collection (acute—
hyperdense, subacute—isodense, chronic—
hypodense)
Crosses suture lines, spreading diffusely over
the convexity (does not cross dural attachment)
May also extend along falx and tentorium
Etiology:
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TRAUMA (most common)—tearing of bridging
cortical veins
Aneurysm rupture
Vascular malformation (dural AVF, AVM)
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High density within the sulci and cisterns
Etiology:
TRAUMA (most common)
 Rupture aneurysm (2nd most common)
 Others (much less common)—AVM,
perimesencephalic venous hemorrhage, etc.
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Traumatic SAH often associated with other
forms of ICH (contusions, SDH, etc.)
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Traumatic axonal stretch injury
Punctate microhemorrhages at grey/white
matter junction, corpus callosum, upper
brainstem
MR much more sensitive than CT—specifically
T2* gradient echo sequence (GRE)
CT is often normal (50-80%)
T2* GRE
Image from UCSD Neuroradiology Teaching File Database-spinwarp.ucsd.edu/neuroweb/