All About Brain Bleeds

All About Brain Bleeds - Imaging and Discussion with Mark McLaughlin, MD NeuroRounds Jan 3 2023 A 4 and a half minute video extracted from our January 3rd #NeuroRounds event. If we covered all this material in 4 minutes 32 seconds, then imagine what you would learn by participating in the incredible teaching event designed for med students, pre-med, practicing medical professionals, and related industries. NeuroRounds is CME approved. Get your free invitation at https://www.markmclaughlinmd.com/neurorounds

The video content:

"This is a good little summary of bleeds. Here's our normal CAT scan…, this will give you some sort of summary of different types of bleeds. Normal CAT scan. This is a subdural hematoma. You can see that acute subdural hematoma where you see that the blood is bright. You know it's hyper and Hyper dense and it's crescentic in nature so it's
following the shape and Contour of the brain as opposed to an epidural hematoma where the blood is outside the dura but inside the skull, and that's where the dura is.

Actually you know it's got an adherence to the inner table of the skull so when you tear a blood vessel that's epidural, it forms this lentiform shaped abnormality. This is a small epidural. Oftentimes they're significantly bigger than that so this is a subdural epidural.

This is an intra-parenchymal hemorrhage. This looks like almost a thalamic hemorrhage origin, but it's not just intra-parenchymal, it's also interventricular. You see that it fills the lateral ventricles as well so…  this is blood that's in the ventricle here with a fluid level.

You can see this flat line so remember a CAT scan is taken with a person laying on their back so blood is going to be denser…, it's going to layer out and it's layering out here.  This is more clotted blood. If we waited a couple days this blood would also layer out,  so we've got intraventricular blood,  intraparenchymal blood related to a thalamic  hemorrhage. This is an intraventricular Hemorrhage on letter e where you have blood in the ventricle not completely casting. Sometimes you'll get a massive interventricular hemorrhage and it will cast the entire ventricle system. That's not the case on this one.  This is just a isolated Intraventricular hemorrhage. This is one form of us and F is one form of subarachnoid hemorrhage.

This is a subarachnoid that looks aneurysmal why is it aneurysmal. Why does it look that way? Because it's in the Basilar cistern here in the Circle of Willis is where aneurysms tend to form and so this would be a highly suspicious pattern of blood for an aneurysm. You can also see intra-hemispheric blood here…,  this white stuff right here.

So this is a person who if they came into the emergency room, typically with “the worst headache of their life”,  they would need to get an angiogram to look at the blood vessels.

Going down to G we have uh blood where this is a person who's had an emergency craniectomy. You can see the skull is missing on this person looks like they have a drain in their head as well. There's some intra parenchymal blood right here. There's some interventricular blood here and they're saying there's some subarachnoid blood.

I don't know if I see subarachnoid blood…, maybe here but this looks like a drain and then there was some subdural Blood on the opposite side as well. You can see
some subdural blood there…

H. intraparenchymal hemorrhage. There's also some stroke here. You can see this hypodensity and subarachnoid. There's interventricular blood you can see it layering in the occipital horn here, and subarachnoid blood.

Maybe this bright spot right here although again this looks so dense, it looks more like a
drain of some sort. Here's another what looks like a drain. This is a probably an intraventricular catheter or EDD and you can see some slight hemorrhage intraparenchymal.  

Another one… combination intraparenchymal blood right here. This is a frontal lobe hemorrhage. Looks like a hemorrhagic stroke, and some subdural blood…  
maybe some subdural blood here.

I'm not seeing a lot of subdural blood and next one sub epidural hematoma which
is this Blood right here. This person has had a craniotomy. You can see the lines here.

And then I didn't get this one. Says subdural hematoma I don't see a subdural there. Maybe up here in the temporal fossa but it's hard to see in one slice. It's not a great slice.

So this is a nice slide to have to compare all the different types of hemorrhages. Any questions?  Anybody got something they want to talk about… share with the group?"