19. Intracerebral bleedings Flashcards
Define intracerebral bleeding
Bleeding withing the brain parenchyma. Type of hemorrhagic stroke
What is the prognosis with intracerebral hemorrhage?
50% of patients die within 30d
Location of intracerebral hemorrhage
- In HT patients: 70% in basal ganglia/thalamic region
- In non-HT patients: 40% in prev. mention area, rest in frontal, temporal, cerebellar etc.
Specific symptoms of bleeding in basal ganglia
Hemiparesis, sensory loss, eye deviation
Specific symptoms of bleeding in thalamus
Sensory loss, later hemiparesis, gaze disturbance
Sepcific symptoms of cerebellar bleeding
Nausea, ataxia, dizziness, signs of brainstem compression
Specific symptoms of bleeding in pons
Fast progressing hemiparesis, disturbed eye movements, decerebration, small pupils, breathing disturbance, coma, death
Etiology of intracerebral hemorrhage
- Hypertension (most common spontanous cause)
- Vasculitis
- CNS infections (HSV)
- Coagulation disorders
- Neoplasms
- Stimulants(cocaine)
- Infections
- Traumatic brain injury
Consequences of intracerebral hemorrhage
Brain shift due to space-occupying effect. Disruption of BBB, edema, neuronal damage and necrosis. Resolution after 4-8 weeks leads to cystic cavity
Symptoms of intracerebral hemorrhage
- Severe headache
- Nausea, vomit
- Confusion, loss of conciousness
- Sympt. progress rapidly (min-hours)
Diagnosis of intracerebral hemorrhage
- Non-contrast CT
- Lab tests (CBC, coag. status, bl.glc.)
Treatment of Intracranial hemorrhage
- Acute stabilization and ICP control
- Medical therapy
- Surgical intervention
Acute stabilisation of ICH
fluids, intubation, head elevation
Medical therapy in ICH
BP control medications (labetalol nicardipine), maintain bl. glc, monitor anticoag tr.
