From the Guidelines
Intracranial hemorrhages are primarily classified into four categories: noncoagulopathic spontaneous intracranial hemorrhage (ICH), coagulopathic spontaneous ICH, noncoagulopathic traumatic intracranial hemorrhage, and coagulopathic traumatic intracranial hemorrhage, with each type having distinct vascular pathologies and locations of bleeding. These categories are based on the underlying cause of the hemorrhage, with spontaneous ICH often resulting from hypertension-related rupture of small penetrating arteries, such as the lenticulostriate arteries supplying the basal ganglia 1. Traumatic intracranial hemorrhages, on the other hand, can result from various mechanisms, including tears in the middle meningeal artery, rupture of bridging veins, or other injuries to the blood vessels in the brain 1. The management of each type of intracranial hemorrhage requires a specific approach, taking into account the underlying vascular pathology and location of bleeding, as well as the presence of any coagulopathy or other complicating factors 1. Some of the key blood vessels involved in intracranial hemorrhages include:
- Middle meningeal artery, which is commonly affected in epidural hemorrhages
- Bridging veins, which are often involved in subdural hemorrhages
- Berry aneurysms in the Circle of Willis, particularly at the anterior communicating artery and posterior communicating artery junctions, which are a common cause of subarachnoid hemorrhages
- Lenticulostriate arteries, which are small penetrating arteries that supply the basal ganglia and are often affected in hypertensive intraparenchymal hemorrhages
- Choroid plexus, which can be a source of bleeding in intraventricular hemorrhages. The most critical factor in managing intracranial hemorrhages is to promptly identify the type and location of the bleed, as well as any underlying coagulopathy or other complicating factors, in order to provide targeted and effective treatment.
From the Research
Types of Intracranial Hemorrhages
- Epidural hemorrhage: typically caused by trauma, associated with middle meningeal artery injury 2
- Subdural hemorrhage: increasingly common in older adults, often caused by trauma or spontaneous bleeding 3
- Subarachnoid hemorrhage: can be caused by traumatic lesions of meningeal arteries or spontaneous rupture of cerebral aneurysms 2
- Intraparenchymal hemorrhage: often associated with hypertension, especially in deep locations such as the basal ganglia, pons, or caudate nucleus 4, 5
Associated Vessels
- Middle meningeal artery: associated with epidural hemorrhage and traumatic aneurysms 2
- Deep perforator arteries: associated with hypertensive arteriopathy and intraparenchymal hemorrhage 5
- Cerebral arteries: associated with subarachnoid hemorrhage and cerebral aneurysms 2
Causes and Risk Factors
- Trauma: a common cause of intracranial hemorrhage, especially in younger adults 4, 2
- Hypertension: a major risk factor for intraparenchymal hemorrhage, especially in deep locations 4, 5
- Vascular malformations: can cause intracranial hemorrhage, especially in younger adults 6
- Anticoagulant therapy: can increase the risk of intracranial hemorrhage, especially in older adults 3, 6