Haemorrhagic Stroke: Intracerebral

Question 1

Definition

Answer 1

Sudden bleeding into brain tissue
Due to rupture of blood vessel within the brain
Like an ischaemic stroke, this leads to infarction, due to O2 deprivation
Pooling of blood increases ICP

Question 2

Epidemiology

Answer 2

Older (>55)
MALE
Asian/Black

Question 3

Risk factors (HAASBATD)

Answer 3

HTN
Age
Alcohol
Smoking
Brain tumours
Anticoagulation
Thrombolysis
Diabetes

Question 4

Pathophysiology

Answer 4

Bleeding within the brain parenchyma itself
= Increased ICP
- Puts pressure on skull, brain and blood vessels
= INFARCTION
CSF obstruction = hydrocephalus
Midline shift
Tentorial herniation
Coning = compression of brain stem

Question 5

Aetiology

Answer 5

Spontaneous due to aneurysm or vessel rupture
Small perforating vessels prone to rupture, especially if hypertensive
- stiff + brittle vessels, prone to rupture
- microaneurysms
Secondary ischaemic stroke
- bleeding after reperfusion
Head trauma
Arteriovenous malformations
Vasculitis
Vascular tumours
Brain tumours
Cerebral amyloid angiography
Carotid artery dissection

Question 6

Signs and symptoms

Answer 6

Will vary depending on cause, size of the bleed and brain region affected
(Basically same as Ischaemic stroke - dependant on ACA, MCA, or PCA

Question 7

What to look out for on history/initial presentation

Answer 7

Sudden loss of consciousness
Severe headache
Meningism
Coma

Question 8

Diagnosis

Answer 8

GOLD STANDARD: Distinguishes haemorrhage from ischaemic
- acute (new/fresh) bleed appears hyperdense on CT (white)
- blood can cause midline shift
Bloods (glucose, FBC, ESR, U+E, Cholesterol, INR,) = DDx
ECG = AF, MI

Question 9

Treatment

Answer 9

Stop all anticoagulants immediately
Reduce ICP = IV Mannitol
Referred for neurological evaluation if:
- Hydrocephalus
- Coma
- Brainstem compression