, or '''intra-axial hematomas''', are a subtype of
Intracranial Hemorrhage that occur within the
Brain tissue itself.
Intra-axial hemorrhages are potentially deadly because they can increase
Intracranial Pressure and crush delicate brain tissue or reduce its blood supply, causing
Ischemia . The other category of intracranial hemorrhage is
Extra-axial Hemorrhage , such as
Epidural ,
Subdural , and
Subarachnoid Hematoma s, which all occur within the skull but outside of the brain tissue.
There are two main kinds of intra-axial hemmorrages: intraparenchymal hemorrhage and intraventricular hemorrhages.
Intraventricular hemorrhage (or "IVH") is a bleeding of the
Ventricle s, where the
Cerebrospinal Fluid is normally located.
It is particularly common in infants, especially
Premature infants or those of very low birth weight (Annibale and Hill, 2003). Most intraventricular hemorrhages occur in the first 72 hours after birth (Annibale and Hill, 2003).
Intraventricular hemorrhage is rare in adults (Mayfrank et al., 1997) and requires a great deal of force to cause. Thus the hemorrhage usually does not occur without an extensive associated damage, and so the outcome is rarely good (Dawodu, 2004; Vinas and Pilistis, 2004).
Brain Contusion s and
Subarachnoid Hemorrhage s are commonly associated with IVH (LeRoux et al., 1992). The bleeding can involve the
Middle Communicating Artery or the
Posterior Communicating Artery . In both adults and infants, IVH can cause dangerous increases in
Intracranial Pressure , damage to the brain tissue, and
Hydrocephalus (Mayfrank et al., 1997; Annibale and Hill, 2003).
Intraparenchymal hemorrhage, or intracerebral hemorrhage, another type of intra-axial bleeding, can be caused by
Brain Trauma , or it can occur spontaneously in
Hemorrhagic Stroke . As with other types of hemorrhages within the skull, intraparenchymal bleeds are a serious
Medical Emergency because they can increase
Intracranial Pressure . The mortality rate for intraparenchymal bleeds is over 40% (Sanders and McKenna, 2001).
More common in adults than in children, intraparenchymal bleeds are usually due to penetrating
Trauma , but can also be due to depressed
Skull Fracture s,
Acceleration-deceleration Trauma (McCaffrey, 2001; Orlando Regional Healthcare, 2004; Shepherd, 2004), rupture of an
Aneurysm or
Arteriovenous Malformation (AVM), and bleeding within a
Tumor .
The risk of death from an intraparenchymal bleed is especially high when the injury occurs in the
Brain Stem (Sanders and McKenna, 2001). Intraparenchymal bleeds within the
Medulla are almost always fatal, because they cause damage to cranial nerve X, the
Vagus Nerve , which plays an important role in
Blood Circulation and breathing (McCaffrey, 2001). This kind of hemorrhage can also occur in the
Cortex or subcortical areas, usually in the
Frontal or
Temporal Lobe s when due to head injury, and sometimes in the
Cerebellum (McCaffrey, 2001; Graham and Gennareli, 2000).
Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed (Vinas and Pilistis, 2004). Other symptoms include those that indicate a rise in
Intracranial Pressure due to a large mass putting pressure on the brain (Vinas and Pilistis, 2004).
Intraparenchymal hemorrhage can be recognized on
CT Scan s because blood appears brighter than other tissue and is separated from the inner table of the skull by brain tissue. The tissue surrounding a bleed is often less dense than the rest of the brain due to edema, and therefore shows up lighter on the CT scan.
Intracerebral hematomas that occur slowly over the course of hours or days are called delayed intracerebral hematomas. These can occur in
Brain Contusion s or in areas in which no abnormality was found in CT scans (Vinas and Pilistis, 2004). These patients appear normal after trauma and then suddenly their condition deteriorates (Vinas and Pilistis, 2004).
An intracerebral hemorrhage continuous with subdural hemorrhage is called a
Burst Lobe .
#Annibale DJ and Hill J. 2003.
Periventricular Hemorrhage-Intraventricular Hemorrhage . Emedicine.com.
# Dawodu S. 2004.
"Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology" Emedicine.com.
# Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. ''Head Injury'', 4th Ed. Morgan Hill, New York.
# LeRoux PD, Haglund MM, Newell DW, Grady MS, and Winn HR. 1992.
"Intraventricular hemorrhage in blunt head trauma: an analysis of 43 cases." ''Neurosurgery''. Volume 4, pp. 678-84. Abstract available.
# Mayfrank L, Kissler J, Raoofi R, Delsing P, Weis J, Kuker W, and Gilsbach JM. 1997.
Ventricular Dilatation in Experimental Intraventricular Hemorrhage in Pigs: Characterization of Cerebrospinal Fluid Dynamics and the Effects of Fibrinolytic Treatment . ''Stroke'', 28:141-148. Full text article available.
# McCaffrey P. 2001.
"The Neuroscience on the Web Series: CMSD 336 Neuropathologies of Language and Cognition." California State University, Chico.
# Orlando Regional Healthcare, Education and Development. 2004.
"Overview of Adult Traumatic Brain Injuries."
# Sanders MJ and McKenna K. 2001. Mosby’s Paramedic Textbook, 2nd revised Ed. Chapter 22, "Head and Facial Trauma." Mosby.
# Shepherd S. 2004.
"Head Trauma." Emedicine.com.
# Vinas FC and Pilitsis J. 2004.
"Penetrating Head Trauma." Emedicine.com.
# Wagner A.L. 2004.
"Subdural Hematoma." Emedicine.com.
