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Intraparenchymal Hemorrhage, Extradural Hemorrhage & Subdural Hemorrhage

Feb 07, 2023

Intraparenchymal Hemorrhage, Extradural Hemorrhage & Subdural Hemorrhage

Strengthen your understanding of the intraparenchymal hemorrhage, extradural hemorrhage and subdural hemorrhage. Read this blog for a quick overview of the topic. 

Also, stay tuned to our blog and enhance your NEET PG exam preparation by covering all the high-yield topics in medicine. 

ENT Residency

Intraparenchymal Bleeding 

Bleeding into the brain parenchyma proper is referred to as Intraparenchymal hemorrhage.

BROCA’S area damage Wernicke’s Damage 
↓Fluency Syntax (Grammar) Expression
 Motor aphasia 
Comprehension lost
Receptive Dysphasia
Word Salad
Fluency is Preserved 
Jargon Speech 

Case Scenario

A 50 year old, HTN (non-compliant with medications) comes with the chief C/O → Facial asymmetry and sudden onset →  Aphasia and weakness in right arm/shoulder 

Provisional diagnosis – LMCA Territory stroke O/E → DTR are Brisk and Babinski sign (+). Non-cooperative with Fundus examination

  • Door to CT scan time <20 min
  • Hyper density/Obstructive 
  • I.P.H/Hydrocephalus 


  • Control of HTN Crisis :> 220/130 – IV Nicardipine
  • Control of Raised ICP → Ventriculostomy 

↓ Fails 

Decompressive Hemicraniectomy 

  • Warfarin ++ → I.P.H.


  • Prothrombin complex concentrate is superior to FFP in warfarin induced Hemorrhage. 

Extradural Hemorrhage

  • Middle meningeal artery is the source bleeding 
  • NCCT heads shows lenticular hyperdensity 
  • Mass effect of CNS bleed leads to obstructive Hydrocephalus
  • Lucid interval [consciousness between 2 periods of unconsciousness] may be present. 

Rx of EDH with Posturing

  • Burr hole 
  • Decompressive Hemicraniectomy. 

Decision for which side to Perform Burr hole is based on

  • CT Scan Report 
  • I/L mid dilated pupil, sluggish  ® to reaction
  • On the left side if pupils are equivocal in response to light.

SDH- Subdural hemorrhage

  • Source of bleeding: Cortical bridging veins

Clinical scenario

70 yr male → Obese, T2 DM, Slipped in Bathroom 7 days back → Bump on head (Subperiosteal Bleeding) + C/O Focal deficit and Arm weakness.

  • People prone to SDH → Stunt actor/ Boxer/ Mixed martial arts
  • Parkinsonian patient
  • Diabetic neuropathy patients
  • Acute SDH shows → Concavo-convex hyperdensity 
  • Chronic SDH shows → After 2-3 weeks hypodensity is there - Black pockets in white blood collection are there due to reabsorption of the blood.

Important Information 

  • Festinating gait. Sensory ataxia later on gradual onset of neurological symptoms. O/E: Fundus shows Papilledema - DTR are Brisk and Babinski sign is elicited. This is the typical history given in exams regarding the chronic SDH.


  • The Sx intervention in these cases is not required in all cases and is dependable on ICH score:

ICH Score components

  • Age
  • GCS
  • Volume of bleed
  • Location of bleed

Important Information
If the patient is >75 yr old and GCS is < 8. volume of bleed > 30 cc and is infratentorial bleed then in these worst scenarios the requirement of Sx intervention is must for management of the patient.

  • Decompressive Hemicraniectomy
    • In other cases where the patient does not have the components mentioned above and got mild neurological deficit then the patient is managed conservatively by:-
    • ORAL Glycerol
    • Acetazolamide

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