Intracranial hemorrhages
Spontaneous (non-traumatic) hemorrhages account for up to 20% of all stroke cases. Unlike cerebral infarction, they much more frequently manifest with pronounced headache and altered consciousness. Hemorrhages can occur both in the cerebral parenchyma and in the submeningeal spaces (subarachnoid, subdural, and epidural), requiring the physician to have flawless knowledge of the anatomy of the meninges.
The primary cause of intracerebral hemorrhage is arterial hypertension. Constantly elevated pressure damages the walls of small arteries, leading to the formation of microaneurysms (so-called Charcot-Bouchard aneurysms). Their spontaneous rupture causes bleeding. Favored locations for such hematomas include the basal ganglia, thalamus, pons, and cerebellar nuclei.
The main danger of the condition lies in the rapid progression of intracranial hypertension. The formed hematoma acts as a space-occupying lesion that physically shifts surrounding structures. This fundamentally distinguishes hemorrhage from ischemia, where pressure rises slowly as cytotoxic edema develops.
Trigeminal neuropathy
Intense facial pain is frequently associated with herpetic involvement of the trigeminal ganglion. In the acute phase (the first three months), the pain syndrome is accompanied by vesicular rashes on the skin and oral mucosa.
If the pain is not relieved for more than three months, postherpetic trigeminal neuralgia is diagnosed. Elderly patients are particularly susceptible to this complication.
The pathogenesis is caused by axonal damage to thick and thin myelin fibers, which triggers spontaneous hyperactivity of neurons in the trigeminal nerve nucleus. Clinically, this manifests as:
- Constant burning pain combined with shooting episodes.
- Sensory disturbances in the affected area (primarily involving the ophthalmic branch, less commonly the maxillary branch).
- Allodynia — attacks are triggered or intensified by ordinary touching of the face.
Glossopharyngeal neuralgia
Glossopharyngeal neuralgia is about ten times less common than trigeminal neuralgia (approximately 0.8 cases per 100,000 population). Disease onset typically occurs in middle and older age (around 50 years), with women being affected twice as often as men.
In most cases, the pathology is idiopathic and associated with vascular compression—the nerve root is compressed by the posterior inferior cerebellar artery at the exit from the brainstem.
Secondary (symptomatic) forms are less common, in which the pain syndrome is triggered by:
- Tumors of the cerebellopontine angle, brainstem, or pharynx.
- Metastases in the neck region.
- Infectious lesions of the tonsils.
- Multiple sclerosis, vascular malformations, or an elongated styloid process.
Space-occupying lesions and hydrocephalus
Headache can also be a consequence of other intracranial space-occupying lesions. Primary brain tumors account for about 2% of all oncology cases. They develop from immature neural and glial cells (astrocytomas, ependymomas), meninges (meningiomas), or embryonic tissues. Genetic predisposition to them is observed in phakomatoses (neurofibromatosis, tuberous sclerosis), while exogenous risk factors include exposure to high doses of ionizing radiation.
Any tumor can cause obstruction of the cerebrospinal fluid pathways. This leads to the development of obstructive (non-communicating) hydrocephalus, in which the normal outflow of cerebrospinal fluid ceases. In rare cases, choroid plexus tumors (papillomas) provoke hypersecretory hydrocephalus due to excessive CSF production.
It is important to distinguish active hydrocephalus from hydrocephalus ex vacuo. The latter is associated with degenerative diseases (Alzheimer's disease, Pick's disease), in which brain tissue undergoes atrophy, and secondary expansion of the CSF spaces occurs.
To differentiate normal pressure hydrocephalus (which may be masked by atypical symptoms), remember the classic clinical triad using the acronym "WET": Walk abnormality (gait apraxia), Dementia, Urination incontinence (urinary incontinence).
Class and exam questions
Can hemorrhage be distinguished from ischemic stroke by the character of the headache?
No, despite the fact that headache is more common in hemorrhage, it is impossible to reliably differentiate these types of strokes based solely on the clinical picture. The method of choice for detecting hemorrhage is computed tomography (CT).
What is allodynia in neuralgia?
This is the pathological occurrence of pain in response to a non-painful stimulus. For example, in a patient with trigeminal neuralgia, a light touch to the innervation zone triggers or sharply intensifies a pain attack.
Which brain tumors are more common: primary or metastatic?
In general clinical practice, secondary (metastatic) tumors arising from malignant neoplasms of the lung, breast, and other organs are more common than primary ones.
What else to study on this topic
- Pathogenesis of Charcot microaneurysm formation in arterial hypertension
- Topical diagnosis of brainstem and basal ganglia lesions
- Classification of primary tumors by degree of morphological differentiation
- Mechanisms of development of compensated and decompensated active hydrocephalus
- Anatomy of the meninges and submeningeal spaces
Master the entire topic in the "Neurology" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on the topic "Headache" and another 907 pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 32 video lessons for the subject
Other topics in the "Additional Topics" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.