Haemorrhagic Stroke: Intracerebral Flashcards
Definition
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
Epidemiology
Older (>55)
MALE
Asian/Black
Risk factors (HAASBATD)
HTN
Age
Alcohol
Smoking
Brain tumours
Anticoagulation
Thrombolysis
Diabetes
Pathophysiology
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
Aetiology
Trauma
Arteriovenous malformation
Cerebral amyloid
Hypertension
Signs and symptoms
Will vary depending on cause, size of the bleed and brain region affected
(Basically same as Ischaemic stroke - dependant on ACA, MCA, or PCA
What to look out for on history/initial presentation
Sudden loss of consciousness
Severe headache
Meningism
Coma
Diagnosis
GOLD STANDARD: Non-contrast CT: 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
Treatment
Stop all anticoagulants immediately
Reduce ICP = IV Mannitol
Referred for neurological evaluation if:
- Hydrocephalus
- Coma
- Brainstem compression
Definitive Mx - coiling or craniotomy and clipping