0:00 Hello, in this video, we're going to talk about intracranial hemorrhage. 0:09 Now intracranial hemorrhage is a broad term, because there are different types 0:14 of hemorrhages 0:15 that can occur within the skull. 0:18 And so you can divide these types of hemorrhages broadly into extra axial 0:23 hemorrhage, meaning 0:24 outside the brain tissue, and then you have intraaxial hemorrhage, which is 0:28 within the 0:29 brain tissue itself. 0:31 Some examples of extra axial hemorrhage include epigural, subjural, and subar 0:37 achnoid hemorrhages. 0:39 And then examples of intraaxial hemorrhage, meaning hemorrhages that occur 0:43 within the 0:44 brain tissue include intracerebral hemorrhage and intraventricular hemorrhage. 0:51 So now let's look at these different types of hemorrhages. 0:54 Let's begin by first looking at the extra axial hemorrhage. 0:58 And again, the definition is bleeding that occurs within the skull, but outside 1:02 the 1:03 brain tissue. 1:04 So let's look at the first example, which is epigural. 1:07 An epigural hemorrhage is a hemorrhage that occurs essentially between the 1:13 skull and the 1:14 jural membrane. 1:15 So here I am drawing a cross section. 1:19 If you're looking straight at a head, we're cutting a section right through the 1:25 head, and 1:26 we can see obviously the brain inside there with the brain stem and the cere 1:32 bellum. 1:33 Now epigural hemorrhage occupies the space between the skull and the jural 1:38 membrane. 1:40 So let's just revise the layers of the cranium now. 1:45 So the layers of the cranium from the top is the scalp, which is your skin, sub 1:51 cutaneous 1:52 fat, et cetera. 1:53 And then you have the bone itself, and then you have the duramata, the arachn 1:57 oid membrane, 1:59 the arachnoid space, the pia matter, and then you have the brain tissue itself. 2:05 So again, an epigural hemorrhage occurs within the duramata, the duramembrane, 2:13 and the bone. 2:15 Epigural hemorrhage often is a result of a trauma to the head, and so about 70 2:22 to 95% 2:23 of epigural hemorrhages present with skull fractures as well. 2:29 Some examples, some causes of epigural hemorrhage include motor vehicle 2:34 accidents, falls, and 2:35 assault, such as a trauma to the head. 2:40 Just to give some more information on epigural hemorrhages, the bleeding occurs 2:46 between the 2:47 duramata and the skull. 2:49 The source of the blood itself is most often arterial, for example, from the 2:55 middle meningial 2:56 artery. 2:57 Clinical manifestations of an epigural hemorrhage include altered state of 3:03 consciousness, headache, 3:04 vomiting, confusion, and seizures, as well as a phagia. 3:10 So that was epigural hemorrhage. 3:13 Now the next one is subjural hemorrhage, and as the name suggests, it's a 3:19 hemorrhage that 3:19 occurs below the duramata. 3:23 So we're doing the same diagram, and we're zooming into this section here. 3:28 And essentially, the hemorrhage occurs between the duramata and the arachnoid 3:35 membrane. 3:36 The causes of subjural hemorrhage are similar, they include motor vehicle 3:41 accidents, falls, 3:42 and assaults. 3:44 Now some more information on subjural hemorrhage. 3:47 Bleeding is between the duramata and the arachnoid membrane. 3:51 The source of blood is often tearing of the bridging veins, so the source of 3:55 blood is 3:55 from the veins. 3:58 Clinical manifestations of subjural hemorrhage are similar to those of epigural 4:03 hemorrhage. 4:04 Subrachnoid hemorrhage occurs in 50% of cases. 4:07 Usually they have lucid interval, which then leads to a progressive neuro 4:12 decline, and 4:12 then coma. 4:16 The final type of extra axial hemorrhage is a subarachnoid hemorrhage, and as 4:20 the name 4:21 suggests, it's within the subarachnoid space. 4:25 And usually, because it occurs in the subarachnoid space, the blood occupies 4:30 the whole area, 4:31 so you can actually engulf the whole brain in a way. 4:34 So if we zoom into this area, we can see that the hemorrhage is within the sub 4:38 arachnoid 4:38 space. 4:40 And it's often a result of the cerebral artery, specifically an aneurysm within 4:46 the artery. 4:47 So the most common cause is rupture of a secular type of aneurysm, and this 4:53 would lead to 4:53 a subarachnoid hemorrhage. 4:56 A secular aneurysm is essentially where you get this sac-looking thing coming 5:03 off the 5:04 artery, and this explodes, resulting in hemorrhage. 5:08 Of course, there are non-anurysmal subarachnoid hemorrhage, but we won't talk 5:13 about that, 5:14 but it's just important to note. 5:16 Now some more information on subarachnoid hemorrhage. 5:19 Again, bleeding occurs within the arachnoid space. 5:24 The loss of blood is from rupturing of an aneurysm, and most common is the 5:29 cerebral arteries. 5:32 The clinical manifestation of subarachnoid hemorrhage is similar to those that 5:36 I mentioned 5:36 earlier. 5:37 However, one key point to make is that subarachnoid hemorrhage often occurs 5:43 with a sudden severe 5:45 headache, thunderclap headache. 5:48 This is obviously also loss of consciousness, and potentially seizure, nausea, 5:53 vomiting, 5:53 and meninges, which is essentially a triad of symptoms relating to irritation 6:02 of the meninges. 6:03 This include a stiff neck, photophobia, and one other thing which I cannot 6:13 remember. 6:14 So those were the three types of extra-axial hemorrhage, epidural, subjural, 6:18 and subarachnoid. 6:20 Now let's look at extra-axial hemorrhage, which as I mentioned in the beginning 6:24 of the 6:24 video is hemorrhage that occurs within the brain tissue. 6:29 So an example is intracerebral hemorrhage, and some more some sub-examples are 6:35 lobar hemorrhage, 6:37 so hemorrhage that occurs in specific lobes of the brain. 6:40 You can have thalamic hemorrhage, so hemorrhage that occurs within the thalamus 6:48 . 6:48 And then you can have ponctine hemorrhage, hemorrhage that occurs in the pons, 6:52 and also 6:53 cerebellar hemorrhage in the cerebellum. 7:01 So some more information on intracerebral hemorrhage is that intracerebral 7:06 hemorrhages 7:06 is the second most common cause of stroke. 7:10 The first most common cause of stroke is embolus or thrombus formation, atheros 7:16 clerosis. 7:18 The causes of intracerebral hemorrhage include hypertension, embolism, brain 7:22 tumour, bleeding 7:23 disorders, and drug use. 7:27 Clinical manifestations include the person possibly gets neurological signs and 7:35 symptoms 7:36 depending on the area affected, headache, nausea, vomiting, and decreased level 7:41 of consciousness. 7:42 Now it's very important to realize that depending on where the hemorrhage 7:47 occurs, so for example, 7:49 the pons, this would result in some serious neurological signs and symptoms 7:54 include problems 7:55 with respiration breathing as well as heart rate, because it's this area, 8:00 including the 8:01 medulla where our respiratory and cardiovascular centers are located. 8:07 So depending on where the hemorrhage occurs, that is where you'll get the 8:11 neurological 8:12 signs and symptoms. 8:14 Now the other type of intraaxial hemorrhage, which is basically within the 8:18 brain tissue, 8:19 is intraventricular hemorrhages. 8:22 And essentially it's bleeding within the ventricles of the brain. 8:25 So bleeding is confined to the ventricle system of the brain. 8:28 It's most often occurs as a secondary phenomenon when intracerebral hemorrhage 8:33 ruptures or 8:34 when subarachnoid hemorrhage extends to the ventricles. 8:38 So essentially intraventricular hemorrhage is secondary to another hemorrhage 8:43 such as a 8:44 subarachnoid hemorrhage or a intracerebral hemorrhage. 8:50 So I hope this video made sense just to recap. 8:55 Subarachnoid hemorrhage includes hemorrhages that occur outside the brain 8:58 tissue and hemorrhages 9:00 that occur within the brain tissue. 9:02 Some examples include epidural, subjural, subarachnoid hemorrhage, and then you 9:06 also 9:07 have intracerebral and intraventricular hemorrhage. 9:10 Thank you for watching. 9:11 I hope you enjoyed this video. 9:12 Bye.
