Spontaneous intracranial haemorrhage

Spontaneous intracranial haemorrhage occurs within the brain (primary intracerebral haemorrhage), into the subarachnoid space (subarachnoid haemorrhage), sometimes into the ventricles (intraventricular haemorrhage), and rarely into the subdural space (subdural haemorrhage). The exact site of origin may not necessarily be immediately obvious because, for example, a saccular aneurysm can rupture into the brain as well as into the subarachnoid space, or disruption of a small perforating artery can cause intraventricular haemorrhage as well as a basal ganglia haematoma. Even at post-mortem there may be uncertainty because the source of the haemorrhage may well have been destroyed, particularly if small (e.g. a tiny intracranial vascular malformation). The causes of intracranial haemorrhage are much the same, whatever the primary site of the bleeding, although their relative frequency varies somewhat with the site.

Causes of spontaneous intracranial haemorrhage

1 Hypertension (chronic, acute)

2 Aneurysms

  • Saccular
  • Atheromatous
  • Mycotic
  • Myxomatous
  • Dissecting

3 Cerebral amyloid angiopathy

4 Intracranial vascular malformations

  • Arteriovenous (cerebral, dural)
  • Venous
  • Cavernous
  • Telangiectasis

5 Haemostatic failure

  • Haemophilia and other coagulation disorders
  • Thrombocytopenia
  • Thrombotic thrombocytopenic purpura
  • Anticoagulation
  • Therapeutic thrombolysis
  • Antiplatelet drugs
  • Polycythaemia rubra vera
  • Essential thrombocythaemia
  • Paraproteinaemias
  • Disseminated intravascular coagulation
  • Renal failure
  • Liver failure
  • Snake bite

6 Inflammatory vascular disease

7 Haemorrhagic transformation of cerebral infarction, venous more often than arterial

8 Intracranial venous thrombosis

9 Sickle-cell disease/trait

10 Moyamoya syndrome

11 Carotid endarterectomy

12 Posterior fossa and other intracranial surgery

13 Delayed post-traumatic "spat-apoplexie"

14 Alcoholic binge

15 Wernicke's encephalopathy

16 Vascular tumours

  • Melanoma
  • Choriocarcinoma
  • Malignant astrocytoma
  • Oligodendroglioma
  • Medulloblastoma
  • Haemangioblastoma
  • Choroid plexus papilloma
  • Hypernephroma
  • Endometrial carcinoma
  • Bronchogenic carcinoma

17 Drug abuse

18 Infections

  • Herpes simplex
  • Leptospirosis
  • Anthrax
  • Chronic meningitis

19 Scorpion bite

20 Silastic dural substitute



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