Thursday, 22 September 2011

Findings in intracranial haemorrhage

While reporting an intracranial bleed following finding should come in a proper order.

Site: Intra axial or extra axial as per classification. If intra axial mention about the anatomical area. If hematoma is sufficiently large and covering more than one anatomical site, first mention about the area which is its epicenter followed by other areas as its extensions. For this one need to know the basic anatomy. If extra axial try to differentiate between Epidural or Subdural.

Size or width: Size of the hematoma is major contributor in mass effect. Size of the hematoma calculated and mentioned in three dimenetions ie along all three axis. If not at least in two dimensions. Measurements must be tangential to each other. The best or ideal method is mentioning the volume of hematoma. In case of extra axial hematoma, whether its extra dural or sub dural, its maximum width is cranio cortical distance across the hematoma and tangential to hematoma.

Age: Acute, subacute or chronic. Mention about acute on chronic or sedimentation in hematoma. Membrane formation in case of SDH if any.
Density: mentioning density of hematoma as hyperdense, isodense or hypodense is better practice than acute, subacute or chronic which is relatively inaccurate. Its better to mention average attenuation value of hematoma in HU.
Perilesional odema:  mention about the amount of odema in terms of degree as mild, moderate and severe; because it contributes in mass effect.

Intra ventricular or subarachnoid space extension: mention in term of degree as mild, moderate and severe. An associated Ventriculomegaly, a known complication of intra ventricular extension and decides prognosis.

Mass effect : Mid line shift is length of a tangential drawn from midpoint of septum pellucidum on a mid line of bony calvarium, mentioned in mm. An associated internal herniation if any subfalcine, uncal or tonsillar herniation. Severity of mid brain compression in terms of mild, moderate or severe.

Any complication: Major intra cranial vessel compression and infarct secondary to internal herniations.

Comparison with the previous study if available: any progression or regression in size of hematoma, mass effect, intra ventricular bleed and Ventriculomegaly. If decompresive craniotomy , mention about changes in mass effect.

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