Cerebral Hemorrhage: Or something else? Differential Diagnosis

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Metabolic derangements, e.g., in the setting of diabetes mellitus or liver disease, in which there may be disturbances of consciousness with emesis (vomiting)

Cardiovascular system (I00-I99).

  • Extracerebral hemorrhage
    • Epidural hematoma (synonyms: epidural hematoma; epidural hemorrhage) – bleeding into the epidural space (space between the bones of the skull and the dura mater (hard meninges, outer boundary of the brain to the skull)).
      • Cause: rupture (tear) of the middle meningeal artery (common) or rupture of a venous sinus (bulge or hollowed structure of venous blood vessels) (rare)
      • Approximately two-thirds of those affected are younger than 40 years; in young children, epidural hematomas are very common after skull injuries in the first two years of life
      • Sex ratio: males to females is 5: 1
    • Subdural hematoma (synonyms: subdural hematoma; subdural hemorrhage; SDH) – bleeding into the subdural space of the skull (between the dura mater (hard meninges) and arachnoid mater (soft meninges or middle meninges)).
      • Acute subdural hematoma (aSDH) – following severe traumatic brain injury (TBI) with brain contusions (brain contusions)Symptoms: Disturbances of consciousness up to unconsciousness
      • Chronic subdural hematoma (cSDH) – especially in elderly patients with minor trauma or spontaneously under therapy with anticoagulants (anticoagulants)Symptoms: uncharacteristic complaints such as a feeling of pressure in the head, cephalgia (headache), vertigo (dizziness), restriction or loss of orientation and ability to concentrate
    • Subarachnoid hemorrhage (SAB) – arterial bleeding into the subarachnoid space (cleft space between the arachnoid mater (soft meninges or middle meninges) and the pia mater (layer of connective tissue directly overlying the brain and spinal cord)).
      • Represents a common, neurologic emergency
      • Cause: rupture of an intracranial aneurysm (pathologic/diseased bulging of vessel walls in the brain) or angioma (benign vascular neoplasm) (rare)
      • Sex ratio: women are more commonly affected than men.
      • Frequency peak: the disease occurs mainly between the 40th and 60th year of life.
      • Incidence (frequency of new cases): 20 diseases per 100,000 inhabitants per year (in Germany).
  • Ischemic apoplexy (stroke due to vascular occlusion).

Psyche – nervous system (F00-F99; G00-G99)

Injuries, poisonings, and other sequelae of external causes (S00-T98).

  • Poisonings