Monday, 2 December 2013

Upper head hemorrhaging: Intracranial hemorrhage - The Diagnosis

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Intracranial hemorrhage
 Intracranial hemorrhage is defined as condition of bleeding within the skull.
D.1.1. Types of Intracranial hemorrhage
In the study to evaluate the sensitivity and specificity of head ultrasound (HUS) in the detection of intracranial hemorrhage in premature neonates compared with brain MRI using susceptibility-weighted imaging (SWI), showed that Ultrasound (US) and MRI scans of the brain using SWI in premature neonates were retrospectively evaluated for grade I-III germinal matrix hemorrhage (GMH), periventricular hemorrhagic infarction (PVHI), intra-axial hemorrhage other than PVHI, extra-axial hemorrhage in each cerebral hemisphere and cerebellar hemorrhage in each cerebellar hemisphere(1).
1. Intra-axial hemorrhage (cerebral hemorrhage)
Intra-axial hemorrhage is defined as a condition of  bleeding in the brain itself, including bleeding of the brain tissues and ventricles,

2. Extra-axial hemorrhage
Extra-axial hemorrhage is defined as a condition of skull bleeding outside of the brain
After a complete physical and history examination, the tests which your doctor may order include
1. Computed tomography (CT)
Computed tomography (CT) is the standard diagnostic tool uses X-rays to make detailed pictures of structures inside the skull to check for fractures and bleeding, specially in case of trauma. Scheduled repeat head computed tomography after mild traumatic brain injury has been shown to have limited use for predicting the need for an intervention. We hypothesized that repeat computed tomography in persons with intracranial hemorrhage and a Glasgow Coma Scale (GCS) score of 13 to 15, without clinical progression of neurologic symptoms, does not impact the need for neurosurgical intervention or discharge GCS scores, according to the study by The University of Texas-Southwestern Medical Center(16).

2.  Lumbar puncture 
If the CT is negative for bleeding, lumbar puncture or a spinal tap may be necessary to collect a sample of cerebrospinal fluid (CSF) to check for the presence of blood. There is a report of two cases of spinal epidural hematoma and two cases of intracranial subdural hematoma after lumbar puncture (LP) are reported in children receiving chemotherapy for acute lymphoblastic leukemia and non-Hodgkin lymphoma. The bleeding was asymptomatic but interfered with treatment in one case, and caused either severe backache or headache but no neurological deficit in the other three patients(17).

3. Magnetic resonance imaging (MRI) can be helpful  in detecting structural abnormalities of the body to determine the extent of injury to the brain. 

4. Arteriography
In case a ruptured aneurysm is suspected, arteriography, a medical imaging technique used to visualize the inside, or lumen, of blood vessels to pinpoint the location of the ruptured aneurysm. 

5. Other tests may be necessary, depending to conditions of the patient and suspection of the doctor.
Some researchers suggested (in case of ttrauma and absence of trauma) that ICH is diagnosed through history, physical examination, and, most commonly, noncontrast CT examination of the brain, which discloses the anatomic bleeding location. Trauma is a common cause. In the absence of trauma, spontaneous intraparenchymal hemorrhage is a common cause associated with hypertension when found in the deep locations such as the basal ganglia, pons, or caudate nucleus(18).

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