Intracerebral haemorrhage Flashcards
what is the definition of ICH?
Acute bleeding within the brain tissue, second most common cause of stroke
what is the epidemiology of ICH?
Older people
30-40% of strokes
Most deadly form of stroke
what is the aetiology of ICH?
Spontaneous due to aneurysm or vessel rupture
Small perforating vessels due to rupture (hypertension)
Can be rarely due to trauma
what are the risk factors for ICH?
Old age
Hypertension
what is the pathophysiology of ICH?
An intracerebral haemorrhage (ICH) is usually caused by rupture of tiny arteries within the brain tissue (left). As blood collects, a hematoma or blood clot forms causing increased pressure on the brain. An ICH can occur close to the surface or in deep areas of the brain.
what are the key presentations of ICH?
Coma
Confusion
Weakness (facial, limbs)
Seizure
Headache
Raised ICP
Suspect stroke in anyone presenting with an acute onset, ongoing focal neurological deficit that cannot be explained by hypoglycaemia or other stroke mimics.
Usually unilateral:
Facial weakness (MCA)
Unilateral weakness of the upper and/or lower limb (MCA/ACA)
Unilateral sensory loss of upper and/or lower limb (MCA/ACA)
Speech problems (MCA, dominant hemisphere)
Visual defects (PCA)
Disorders of perception (PCA)
Disorders of balance (posterior circulation)
Coordination disorders (posterior circulation)
what are the signs of ICH?
Signs of raised ICP
what are the symptoms of ICH?
Severe headache or coma
what are the first line and gold standard investigations for ICH?
Acute fresh blood - bright white on CT
Blood in substance of brain
Mass effect seen if large - midline shift
Serum glucose - may be abnormal
Serum electrolytes - may be abnormal
Serum urea and creatinine - may show renal failure
LFT - may show liver dysfunction
FBC - anaemia or thrombocytopenia
Clotting screen - normal
ECG - may show arrhythmia or signs of ischaemia
what are the differential diagnoses for ICH?
Ischaemic stroke, SAH, TIA, acute hypertensive crisis, sentinel headache
how is ICH managed?
Treatment within the first three hours of the onset of symptoms generally results in a better outcome. Surgery can relieve pressure on the brain and repair torn arteries. Certain medications can help manage symptoms, such as painkillers to ease severe headaches.
Referral to neurosurgery, blood pressure control, reversal of anticoagulation, venous thromboembolism prophylaxis and early mobilisation
how is ICH monitored?
Closely monitor for signs of increased ICP
what are the complications of ICH?
Haematoma expansion, perihematomal oedema with increased intracranial pressure, intraventricular extension of haemorrhage with hydrocephalus, seizures, venous thrombotic events, hyperglycaemia, increased blood pressure, fever, and infections
what is the prognosis of ICH?
Intracerebral haemorrhage (ICH) accounts for 10% to 15% of all stroke cases and is associated with a high risk of death and disability. The 30-day mortality in patients with nontraumatic ICH is about 40%, and 12% to 39% of surviving patients are functionally independent poststroke.
