Intracerebral haemorrhage Flashcards
Define intracerebral haemorrhage
Sudden bleeding into brain tissue due to rupture of blood vessels, leading to infarction due to O2 deprivation. Pooling of blood increases ICP. 10% of strokes, 50%
mortality.
What are the risk factors for intracerebral haemorrhage?
- Hypertension – uncontrolled HTN is almost always the cause
- Age
- Alcohol
- Smoking
- Diabetes
- Anticoagulation/Thrombolysis
What are causes of intracerebral haemorrhages?
Anything that increases the risk of a vessel rupturing
- Hypertension - causes stiff, brittle vessels prone to rupture, microaneurysms
- 2° to ischaemic stroke - bleeding after reperfusion
- Head trauma
- AV malformations
- Vasculitis
- Vascular/Brain tumours
- Cerebral amyloid angiopathy - amyloid beta deposits in small/medium vessels
- Carotid artery dissection
What can increased intracranial pressure lead to?
- Pooling of blood puts pressure on brain
- May cause CSF obstruction - hydrocephalus
- Leading to midline shift/tentorial herniation
- Eventually coning - brain stem compression - Death
What is the clinical presentation of a intracerebral haemorrhage?
Virtually indistinguishable from ischemic infarct
- CT head needed
- More likely to lose consciousness
- More likely to have headache (usually sudden onset)
What is are the treatments for intracerebral haemorrhage?
- Coagulation -
- Stop anticoagulants immediately
- Reverse with clotting factor replacement if needed (Beriplex + vitamin k if on warfarin) - BP control
- Reducing ICP -
IV mannitol
Mechanical ventilation if needed - Neurosurgical referral -
Decompression/shunting may be required
How is BP controlled for the treatment of intracerebral haemorrhage?
- Consider rapid BP lowering if <6 hours before onset and systolic BP is between 150-220
mmHg - Aim to lower below 140 mmHg systolic
- Contraindicated: underlying structural cause, GCS below 6, early neurosurgery, poor
prognosis
