Peds Radiology Case - Intracranial Hemorrhage Flashcards Preview

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Flashcards in Peds Radiology Case - Intracranial Hemorrhage Deck (34)
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1
Q

List the 5 types of presentation of intracranial hemorrhage.

A
  1. Subdural hematoma
  2. Epidural hematoma
  3. Subarachnoid hemorrhage
  4. Intracerebral hemorrhage
  5. Intraventricular hemorrhage
2
Q

What is the optimal imaging procedure to evaluate suspected intracranial hemorrhage?

A

Pre-contrast CT scan

3
Q

How does acute hematoma appear on pre-contrast CT imaging?

A

Area of high density

4
Q

CT can detect acute intracerebral blood as small as 2 mm - why?

A

Due to the contrast between high density of blood and low density of surroudning brain.

5
Q

List 10 etiologies for intracranial hemorrhage.

A
  1. Trauma
  2. Aneurysm/AVM rupture
  3. Tumors
  4. Stroke with reperfusion
  5. Venous infarction
  6. Vasculitis
  7. Eclampsia
  8. Amyloid angiopathy in elderly
  9. Hypertension
  10. Coagulopathy
6
Q

Define epidural hematoma.

A

Collection of blood between the inner table of the skull and the dura

7
Q

Common etiology of epidural hematoma?

A

Head trauma

8
Q

Why is epidural hematoma more common in chidlren?

A

Dura is not as well fixed to the skull in children as it is in adults

9
Q

Where are epidural hematomas commonly located and why?

A

Temporoparietal and parieto-occipital regions, because the fracture line occurs across the middle meningeal artery groove in 85-95% of cases

10
Q

Presentation of epidural hematoma?

A

Patients may present with a classic lucid interval with initial period of loss of consciousness followed by a lucid interval of no symptoms with subsequent neurological deterioration leading to coma

11
Q

Treatment of epidural hematoma?

A

Immediate neurosurgical evacuation, as the hematoma is the result of an arterial bleed

12
Q

What are the pre-contrast CT findings of an epidural hematoma?

A

Biconvex in shape
Acute blood is hyperdense (30-80 HU)
Does not cross suture lines (localized)
Mass effect due to hemorrhage and edema

13
Q

Define subdural hematoma.

A

Collection of blood between the dura and the arachnoid.

14
Q

Common etiologies of subdural hematoma?

A

Head trauma (child abuse), coagulopathy

15
Q

What causes a subdural hematoma?

A

Movement of the brain relative to the skull, as in an acceleration-deceleration injury, resulting in tearing of a cortical vein coursing within the subdural space

16
Q

Why is subdural hematoma more common in patients with brain atrophy?

A

Because the superficial veins are stretched over greater distances and are therefore more prone to rupture with rapid head movement

17
Q

Which is more common - epidural or subdural hematoma?

A

Subdural

18
Q

Which blood vessels are typically injured in subdural hematoma?

A

Veins (vs. epidural, which injures arteries) - this causes a delay in clinical signs

19
Q

How can subdural hematoma be classified by CT imaging?

A

Acute (0-2 days), subacute (3-14 days), and chronic (after 2 weeks)

20
Q

How does an acute subdural hematoma appear on CT?

A

Blood appears hyperdense (30-80 HU), crescentic shape (medial margin is not convex as in epidural hematoma), crosses suture lines and spreads diffusely over the brain surface, can cause significant mass effect leading to brain herniation

21
Q

How does a chronic subdural hematoma (aka hygroma) appear on CT?

A

Appears hypodense (lucent) as the cellular elements dissolve; blood products are absorbed with time and change to clear liquid.

22
Q

How does a subacute subdural hematoma appear on CT?

A

Isodense, can be easily missed

23
Q

Define subarachnoid hemorrhage.

A

Blood within the CSF subarachnoid space

24
Q

What causes subarachnoid hemorrhage?

A

Tears of small subarachnoid vessels either spontaneously or post-trauma

25
Q

How do subarachnoid hemorrhages classically present?

A

Atypical headaches that are abrupt in onset and severe (“worst headache of my life”)

26
Q

What is the most common cause of subarachnoid hemorrhage? What is the most common cause of spontaneous subarachnoid hemorrhage?

A

Trauma; rupture of arterial aneurysms which release blood directly into the CSF

27
Q

How does subarachnoid hemorrhage appear on CT?

A

Blood in the sulci and subarachnoid space (normal sulci are filled with low density normal CSF and appear dark - sulci filled with blood appear hyperdense)

28
Q

Clinical effects of intracranial hemorrhage vary, but many patients exhibit ___.

A

Impaired consciousness

29
Q

What are the most common causes of intracerebral hemorrhage?

A

HTN, trauma, rupture of aneurysm or AVM, tumor-related, bleeding diatheses, illict drug use, and amyloid angiopathy in the elderly

30
Q

Intraventricular hemorrhages are most common in what patient population?

A

Premature infants (most occur in the first 72 hours after premature birth)

31
Q

In adults, what is the most common cause of intraventricular hemorrhage?

A

TBI

32
Q

In intraventricular hemorrhage, blood clots can block the flow of CSF and cause ___.

A

Hydrocephalus

33
Q

What three things appear hyperdense on CT in the brain?

A

Hemorrhage, calcium, and contrast (which is why we need to look at non-contrast CT for hemorrhage)

34
Q

List the steps in systematic evaluation of imaging study in suspected cases of intracranial hemorrhage.

A
  1. Locate the site of hemorrhage (ventricle, sulci, brain parenchyma, peripheral surface of the brain, etc.)
  2. Describe the shape of the density (round, biconvex, crescentic, etc.)
  3. Look for edema around the hemorrhage manifested as a hypolucent area
  4. Look for midline shift and brain herniation
  5. Look for fractured skull and soft tissue hematomas, as many patients fall and sustain head injury.