1. Intracranial Hemorrhage
Nikdokht Farid, M.D.
Assistant Professor
UCSD Department of Radiology

2. 25 year old male status post severe head trauma

4. Repeat CT few hours later…

9. Cerebral Contusion
Patchy multifocal superficial hemorrhages surrounded by edema
Anterior inferior frontal and temporal lobes are most common site (“frontal and temporal poles”)
Coup and contracoup injury sites
Often associated with subdural hematoma (SDH), traumatic subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH)
“Blossoming” of contusions may occur (ongoing hemorrhage or worsening edema)

10. 20 year old female status post head trauma, “lucid interval” prior to ALOC

15. Epidural Hematoma-EDH
Biconvex or lentiform extra-axial collection—usually hyperdense (low density “swirl sign”)
Does not cross suture lines
90% arterial, 10% venous
Arterial EDH often associated with fracture near middle meningeal artery groove
Venous EDH often associated with fracture near dural sinus attachment
Mass effect on underlying brain and subarachnoid space

16. 30 year old female with sudden onset severe headache and altered mental status

21. CT Angiogram— Ruptured right PCOM aneurysm

25. Subdural Hematoma-SDH
Crescentic extra-axial collection (acute—hyperdense, subacute—isodense, chronic—hypodense)
Crosses suture lines, spreading diffusely over the convexity (does not cross dural attachment)
May also extend along falx and tentorium
Etiology:
TRAUMA (most common)—tearing of bridging cortical veins
Aneurysm rupture
Vascular malformation (dural AVF, AVM)

26. 75 year old female with repeated falls, altered mental status

29. Chronic SDH with marked mass effect on left cerebral hemisphere resulting in “trapping” of the right lateral ventricle with transependymal flow of CSF

30. 35 year old male status post trauma

35. Subdural hematoma layering along the tentorium

36. 60 year old male status post trauma

41. Subarachnoid Hemorrhage-SAH
High density within the sulci and cisterns
Etiology:
TRAUMA (most common)
Rupture aneurysm (2nd most common)
Others (much less common)—AVM, perimesencephalic venous hemorrhage, etc.
Traumatic SAH often associated with other forms of ICH (contusions, SDH, etc.)

42. 40 year old female presenting with “worst headache of life”

49. Cerebral Angiogram- Ruptured right ICA terminus aneurysm

56. 40 year old male status post trauma

62. Combination ICH: SDH, SAH, IVH, contusions

63. 45 year old female with sudden onset ataxia, nausea, vomiting

70. Large left cerebellar AVM with bleed

71. Diffuse axonal injury Traumatic axonal stretch injury
Punctate microhemorrhages at grey/white matter junction, corpus callosum, upper brainstem
MR much more sensitive than CT—specifically T2* gradient echo sequence (GRE)
CT is often normal (50-80%)

72. T2* GRE
Image from UCSD Neuroradiology Teaching File Database--spinwarp.ucsd.edu/neuroweb/