After the car accident, the man with brain trauma insisted on going home. Fortunately, he met the doctor in charge...

*For medical professionals' reference only, "I let him go, I'm sorry for my first aid job!" Recently, CCTV News reported that a man riding an electric bike was rushed to the scene to avoid an accidental fall of the car.
After a physical examination, it was found that although the man had obvious bruises on the head, he was not physically active and conscious, but he did not remember the specific circumstances of the car accident and he even vomited once.
After years of experience in the doctor’s judgment, the man did not seem to be injured.
Seriously, there may have been severe head injuries inside.
The man was advised to follow the ambulance to the hospital immediately for a comprehensive examination.
However, the man insisted on leaving after several refusals.
Fortunately, the doctor and the traffic police brought the man back forcibly.
When he took the ambulance, the man became unconscious.
.
.
Video source: SBS Warm Video went back to the hospital and found that the man had severe intracranial hemorrhage through a head CT examination.
He was in a critical condition.
After three craniotomy operations, the patient was relieved.
It is not that the doctor insists on taking the patient back to the hospital with the heart of saving people.
After the patient returns home, no matter how good the condition is, it will leave sequelae such as hemiplegia, dementia, etc.
, or even die directly.

Figure 1: The results of the patient’s CT examination showed that the emergency doctor of the man with intracranial hemorrhage said, “At that time, I had actually fulfilled my duty to inform, but if I let him go, I’m sorry for my first aid job!” In this case, although the patient suffered no trauma It is severe, but severe intracranial hemorrhage has occurred.

This reminds us that in car accidents, hidden injuries such as intracranial hemorrhage are often not directly observed with the naked eye, but they are more dangerous and must be checked in the hospital.
An emergency like intracranial hemorrhage requires doctors to find out in time and accurately.
Efficient and standardized diagnosis and treatment can save patients' lives in the first place.

What signals after a car accident can indicate that our patient has intracranial hemorrhage? In addition to obvious coma and severe headaches, vomiting, mild headaches, dizziness, dizziness, retrograde amnesia, etc.
can also indicate that our patients have had intracranial hemorrhage and require timely treatment.1.
Nausea or direct vomiting 2.
Drowsiness or coma 3.
Severe headache, dizziness, inattention 4.
Diplopia, blurred vision 5.
Irregular pulse, breathing, etc.
6.
What are the risk factors for intracranial hemorrhage, irritability ? Intracranial hemorrhage is divided into two major categories clinically, traumatic intracranial hemorrhage and non-traumatic intracranial hemorrhage.

Traumatic intracranial hemorrhage includes epidural hematoma, subdural hematoma, subarachnoid hemorrhage, etc.
; non-traumatic intracranial hemorrhage includes hypertensive cerebral hemorrhage, amyloid vascular disease, and vascular malformations.

Different types of bleeding risk factors are different.
The most important risk factor is obvious head trauma.
For non-traumatic intracranial hemorrhage, the risk factors include: hypertension, diabetes, advanced age, smoking, drinking, obesity, etc.

But no matter what kind of hemorrhage, it will stimulate and destroy brain cells through blood components, as well as the pressure of hemorrhage on peripheral nerve tissues, resulting in a series of neurological dysfunction.

Next, introduce the imaging manifestations of several common intracranial hemorrhages.
1 Epidural hematoma.
Epidural hematoma is a hematoma located between the inner plate of the skull and the dura.
It usually occurs on the convex surface of the supratentorial hemisphere and accounts for about traumatic intracranial.
Hematoma is 30%.

The clinical manifestations vary with bleeding speed, location, and age, and mainly include disturbances in consciousness, pupil changes, pyramidal tract signs, and changes in vital signs.
There may be a typical intermediate awake period.

According to the time of the formation of hematoma after trauma, epidural hematoma can be divided into very acute (within 3 hours after trauma), acute (3 hours to 3 days), subacute (3 days to 3 weeks), chronic subdural hematoma (More than 3 weeks).

Imaging findings: ① Location and morphology: The supratentorial part, especially the temporal part, is the most common.
It is mostly single and fusiform.

②CT presents a biconvex, high-density shadow with clear edges and uniform or uneven density.

③The appearance of MRI is more complicated: its morphological changes are consistent with those seen on CT, and the signal intensity is related to the age of the hematoma and the MR field strength.

Figure 2: Schematic diagram of epidural hematoma and CT findings 2 Subdural hematoma Subdural hematoma refers to the accumulation of intracranial hemorrhage and blood in the subdural space, which has the highest incidence in intracranial hemorrhage.

Seen within 3 days after trauma, of which 6 hours is the hyperacute phase.

The clinical manifestations are mainly increased intracranial pressure, such as headache, vomiting, papilledema, and disturbance of consciousness.

Unlike epidural hematoma, there is no intermediate awake period in the disorder of consciousness, and it often loses consciousness several hours after trauma.

Imaging findings: ① Location and morphology: The hematoma is located between the arachnoid and dura mater.
The convex surface of the supratentorial brain is the most common, and the hematoma is crescent-shaped.

② CT plain scan: the hyperacute phase (<6 hours) is mostly equal or slightly low density, and most of the cases thereafter are uniform high density.

③MR examination: On T1WI, the hyperacute phase is iso-signal, and the acute phase is wait until slightly lower signal.

The hyperacute phase on T2WI and FLAIR is equal or high signal, and the acute phase is low signal.

Figure 3: Schematic diagram and CT findings of subdural hematoma 3 Subarachnoid hemorrhage Subarachnoid hemorrhage (SAH) refers to a type of clinical symptoms caused by blood flowing into the subarachnoid space after a blood vessel ruptures at the bottom of the brain or on the surface of the brain Intracranial hemorrhage.

According to whether there is a cause of trauma, SAH is divided into traumatic SAH and spontaneous SAH.
The latter is mostly caused by aneurysms or vascular malformations.

The most common clinical manifestations are sudden headache, nausea, vomiting, and disturbance of consciousness.
Physical examination shows signs of meningeal irritation and increased intracranial pressure.

Imaging findings: ①Unenhanced CT scan showed high-density cerebrospinal fluid cavity, the most common are the sulcus, longitudinal fissure cistern, lateral fissure and frontotemporal sulcus.

② MR examination is not sensitive to T1WI and T2WI in the acute phase.
FLAIR is of great significance for the diagnosis of SAH.
It can show a small amount of bleeding that cannot be detected by conventional CT and MRI.
MRA can help to show aneurysms and vascular malformations that cause bleeding.

Figure 4: CT findings of subarachnoid hemorrhage 4 Hypertensive cerebral hemorrhage Hypertensive cerebral hemorrhage is due to systemic hypertension and rupture of blood vessels in the brain parenchymal hemorrhage, accounting for more than 50% of non-traumatic intracranial hemorrhage.

The clinical manifestations are related to the location and size of the bleeding, and common disturbances of consciousness, hemiplegia, headache, vomiting, and increased intracranial pressure are common.

Imaging findings: ① Location and morphology: the basal nucleus-external capsule area is the most common, followed by the thalamus, brainstem and cerebellum, and a few are located in the brain lobe.

Generally single, multiple ones are rare, ranging in size from punctate to several centimeters, kidney-shaped, round-like or massive.

A certain degree of perifocal edema and space-occupying signs can be seen; ②The acute stage of CT scan is high-density lesions; ③MRI examination: the changes of hematoma signal have distinct time characteristics.

Figure 5: Schematic diagram of hypertensive cerebral hemorrhage and CT findings 5 ​​Amyloid angiopathy Cerebral amyloid angiopathy (CAA) is the most common cerebral amyloid lesion, and is the most common cause of non-hypertensive cerebral hemorrhage in the elderly, accounting for approximately In patients over 60 years old, the cause of cerebral hemorrhage is 11%-15% and the cause of cerebral lobe hemorrhage is 1/3-3/4.

The clinical features of CAA are recurrent lobar hemorrhage, localized neurological dysfunction, dementia and psychiatric symptoms.

Imaging manifestations: ① Location and morphology: The occipital lobe, temporal lobe, and parietal lobe are the most common ones.
It can also involve the frontal lobe, brainstem, and cerebellum.
It is more common under the cortex, but the deep brain parenchyma is less affected.

Cerebral lobe hemorrhage lesions are relatively large, and there are often punctate or nodular lesions under the cortex; ② CT plain scan: the acute phase shows high-density brain lobes, surrounded by edema of varying degrees.

③MRI shows cerebral hemorrhage of different ages, and the evolution of hemorrhage is similar to hypertensive cerebral hemorrhage.

Figure 6: Schematic diagram and imaging of CAA 6 Arteriovenous malformations Cerebral arteriovenous malformations (AVM) are one of the most common intracranial vascular malformations, and they are also the most common vascular malformations that cause clinical symptoms (mainly intracranial hemorrhage).

Symptoms usually appear between 20-40 years old.
The clinical manifestations are often caused by cerebral hemorrhage.
Others include neurological dysfunction caused by convulsions and theft of blood.

Imaging examination: ① Location and morphology: most of them are located in the supratentorial brain parenchyma, a small part are located in the cerebellum, brainstem, and spinal cord.

② CT plain scan: the smaller AVM may not be displayed, the larger one shows a tortuous strip or high-density shadow, and about 1/3 of the calcification can be seen.

③MR examination: T2WI shows better the empty signal of the diseased blood vessel, showing a honeycomb mass with tortuous empty signal inside, and SWI shows low signal caused by hemorrhage.

Figure 7: AVM imaging shows common treatments for intracranial hemorrhage.
Regardless of the type of intracranial hemorrhage, the treatment includes general treatment, drug treatment, surgical treatment and rehabilitation.

■ General treatment: bed rest, keeping the airway unobstructed, oxygen inhalation, nasal feeding, ECG monitoring, infection prevention, etc.

■ Medication: including rational use of dehydrating drugs, hemostatic drugs, and preventive use of antibiotics and other drugs when necessary.

■ Surgical treatment: If the patient has a large amount of bleeding (suppermental hemorrhage> 30ml, subtentorial hemorrhage> 10ml), or the patient's consciousness is still getting worse after drug treatment, surgical treatment should be considered as soon as possible.

Commonly used surgical methods include craniotomy to remove hematoma, puncture and aspiration of hematoma, neuroendoscopy to remove hematoma, and ventricle puncture and drainage of hematoma.

■ Recovery treatment: Put the affected limb in the functional position at an early stage.
If the condition permits, after the dangerous period, the limb function, speech disorder and psychological rehabilitation should be carried out as soon as possible.

Summary: Intracranial hemorrhage is a common clinical emergency and requires everyone to raise their awareness.

Head trauma often leads to subdural hematoma, epidural hematoma, traumatic intracerebral hematoma, and subarachnoid hemorrhage.
Patients with a history of hypertension are more likely to have hemorrhages in the basal ganglia, thalamus, brainstem, and cerebellum.

Trauma history and past medical history have important reference value in the diagnosis of intracranial hemorrhage.

Regardless of the type of bleeding, headache, vomiting, hemiplegia, and aphasia may occur in mild cases, and unconsciousness, coma, and even life-threatening may occur in severe cases.

Therefore, for patients who are considering the possibility of intracranial hemorrhage, they should go to the hospital as soon as possible to complete related examinations such as head CT, and treat them in time to avoid delaying the condition.

Reference: Chinese Medical Association Neurology Branch, "Guidelines for the Diagnosis and Treatment of Cerebral Hemorrhage in China (2019)" [J] Chinese Journal of Neurology 2019,12(52),994-1005 Text first: Medical Neurology Channel Article Author: Liny Review: Li Tuming Deputy Chief Physician Editor: Mr.
Lu Li Copyright Statement Word document format, the author's remuneration is favorably edited WeChat: chenaff0911