A19. Intracerebral bleedings Flashcards
(39 cards)
Intracerebral hemorrhage (ICH) definition
- Bleeding within the brain parenchyma
Intracerebral hemorrhage is most common in patients with
- hypertension
Intracerebral hemorrhage is a type of
- type of hemorrhagic stroke,
accounts for 10% of strokes
30 day prognosis in patients diagnosed with Intracerebral bleedings
approximately half of patients
die within 30 days.
Hemorrhagic stroke
definition
Rupture of a blood vessel within the brain or the cerebrospinal fluid
Hemorrhagic stroke subtypes
- Intracerebral hemorrhage (intraparenchymal hemorrhage): bleeding within the brain parenchyma
- Subarachnoid hemorrhage: bleeding into the subarachnoid space
- Intraventricular hemorrhage: bleeding within the ventricles
Intracerebral hemorrhage can it rupture? what happens?
Can rupture through to the cortical surface to produce
* associated SAH (Subarachnoid hemorrhage )
or
* into the ventricular system. (30%)
Intracerebral hemorrhage most commonly affects which structures of the brain?
Most commonly affects the deep structures of the brain
common sites of intracerebral hemorrhage in hypertensive patients
hypertensive patients 70% occur in the basal ganglia/thalamic region
common sites of intracerebral hemorrhage In normotensive patients
- 37% occur in basal ganglia/thalamic region
- frontal,
- temporal,
- parieto-occipital,
- cerebellar and
- pontine areas.
Supratentorial hematomas can have
mass effect
(sudden headache with deteriorating consciousness)
and focal signs.
Intracerebral hemorrhage in Basal ganglia symptoms
Hemiparesis,
sensory loss,
eye deviation
symptoms of ICH(intracerebral) in Thalamus
- Sensory loss,
- later hemiparesis,
- gaze disturbance
Lobar ICH(intracerebral) prognosis
Better prognosis, intraventricular bleeding is rare
Cerebellar ICH (intracerebral)
- Nausea
- ataxia,
- dizziness,
- signs of brainstem compression (30% mortality)
signs of brainstem compression is seen in
cerebellar intracerebral hemorrhage
symptoms of ICH(intracerebra) in Pons
- Fast progressing hemi- or tetraparesis
- disturbed eye movements,
- decerebration,
- small pupils
- disturbance of breathing
- coma
- death (high mortality)
Intracerebral hemorrhage etiology
A. Nontraumatic
● Hypertension - Most common cause of spontaneous ICH, vessel wall lipohyalinosis and
Charcot-Boucard microaneurysms
● Cerebral amyloid angiopathy - Beta-amyloid in vessel walls
● Ruptured arteriovenous malformations - Excessive strain
● Vasculitis (e.g. giant cell arteritis)
● CNS infections (e.g. HSV encephalitis) and septic emboli
● Coagulation disorders (e.g. , hemophilia, anticoagulant use)
● Neoplasms (e.g. meningioma)
● Stimulants (e.g. cocaine, amphetamines) possibly also caffeine
● Infarctions (venous sinus thrombosis, hemorrhagic)
● Ischemic stroke (due to reperfusion injury)
B. Traumatic brain injury - Vessel damage
C. Idiopathic
why is hypertension the most common cause of spontaneous ICH
Hypertension-induced hemorrhages typically occur in the subcortical regions.
Small penetrating arteries supply this part of the brain and emerge at sharp angles from larger vessels, making them particularly sensitive to changes in blood pressure.
most common cause of spontaneous ICH in individuals > 60 years of age
Cerebral amyloid angiopathy
most common cause of spontaneous intracerebral hemorrhage in children
Arteriovenous malformations
how can meningioma cause ICH
due to the invasion of vessels by tumor cells
or
malignancy-associated coagulopathy
Intracerebral hemorrhage Pathological effects
● Space-occupying effect → Brain shift
● Continued bleeding → Expanding may continue beyond the first few
hours.
● Within 48 hours:
disruption of BBB,
vasogenic and cytotoxic edema, neuronal damage and
necrosis
● Resolution in 4-8 weeks → Cystic cavity
Pathological effects of ICH within 48 hrs
Within 48 hours:
* disruption of BBB,
* vasogenic and cytotoxic edema,
* neuronal damage and
* necrosis
