ICH

Question 1

ICH

Answer 1

Spontaneous rupture of blood vessels
in the cerebral parenchyma
Leading to focal haematoma formation and
Subsequent mass effect

Question 2

types of brain hemorrhage

Answer 2

epidural hematoma, subdural hematoma, subarachnoid hemorrhage, ICH

Question 3

Primary ICH causes

Answer 3

Primary (80%)
hypertensive arteriopathy (70%)
Amyloid angiopathy
Eclampsia

Question 4

Secondary ICH causes

Answer 4

Secondary-
Bleeding from pre-existing lesion
Coagulopathies (including drug-induced disorders)
malformations

Question 5

localisation of ICH

Answer 5

Supratentorial haemorrhages (85%)
-cortical, lobar (30-35%)
- deep haematomas – basal ganglia, internal capsule, thalamus (35%)
2) Infratentorial haemorrhages (15%)
-cerebellar (5-10%)
-brainstem (5%)
3) Intraventricular haemorrhages

Question 6

causes

Answer 6

Hypertension
Vascular malformations: aneurysm, AVM, cavernoma, venous sinus thrombosis
Trauma
Bleeding in pre-exsiting lesions – tumours/haemorrhagic transformation
Infection –mycotic aneurysms
Angiopathies
Coagulopathies
Drugs

Question 7

hypertension causing ICH

Answer 7

Most common cause of ICH
2 mechanisms causing bleeding:
1) rupture of artery affected by chronic HTN
2) acute/subacute severe hypertension –rupture of previously unaffected artery (malignant HTN)
Basal ganglia, thalamus, pons, cerebellum
HTN leads to lipohyalinosis of small arteries

Question 8

Coagulopathies causing ICH

Answer 8

Anticoagulants- risk of ICH with long term anticoagulants 2%

Antiplatelets – 1% (increased if on two different antiplatelets)

Fibrinolytics -4-6%
Other coagulopathies – leukemia, liver disease (alcohol), thrombocytopenia

Question 9

Angiopathies (abnormal vessels) causing ICH

Answer 9

Cerebral amyloid angiopathies
50-60 yo
Beta-amyloid deposits in small/medium cerebral arteries
Lobar haematomas/repeated microhaemorrhages

Vasculitis – e.g. Polyarteritis nodosa/SLE/syphilis

Question 10

vascular abnormality causing ICH symptoms

Answer 10

Aneurysm: sudden onset headache, photophobia, neck stiffness
AVM: seizure
Cavernoma: seizure
venous sinus thrombosis : headache, visual disturbance
(Hypertensive) : hypertension
Haemorrhagic stroke: stroke presentation

Question 11

management

Answer 11

Correct clotting – Vit K antagonist (combination of Prothrombin complex and IV vitamin K). Patients on DOAC should also be considered for reversal.

Control BP – SBP 150-220 –treat immediately within 6 hours of symptom onset to achieve 130-139mmHg within 1 hour and sustained for 7 days