Intracerebral Haemorrhage

Question 1

How are ICH classified according to aetiology (cause)?

Answer 1

Primary (80%)
Secondary (20%)

Question 2

What is an Intracranial Hemorrhage (ICH)?

Answer 2

Spontaneous rupture of blood vessels within cerebral parenchyma
- This leads to focal haematoma formation

Question 3

What can cause primary ICH?

Answer 3

Hypertensive arteriopathy (70%)
Amyloid angiopathy
Eclampsia

Question 4

What can cause secondary ICH?

Answer 4

Bleeding from pre-existing lesion
Coagulopathies
Malformations

Question 5

Where are ICH most common?

Answer 5

Supratentorial hemorrhages (85%)
- Cortical, Lobar (30-35%)
- Deep haematomas - Basal ganglia, internal capsule, thalamus (35%)

Question 6

Where else apart from supratentorial can ICH occur?

Answer 6

Infratentorial haemorrhage (15%)
- Cerebellar (5-10%)
- Brainstem (5%)
Intraventricular haemorrhage

Question 7

What are angiopathies?

Answer 7

Abnormal vessels

Question 8

How does ICH present?

Answer 8

Headache
Reduced GCS
Nausea & vomiting
Raised ICP
Pupillary defect

Aneurysm: SUDDEN onset headache, Photophobia, Neck stiffness

Arteriovenous malformation (AVM): Seizure

Cavernoma: Seizure

Venous sinus thrombosis: Headache, visual disturbance

Question 9

What are the management options for ICH?

Answer 9

• Correct clotting - Vit K antagonist
• Control BP - SBP 150-220 treat immediately to achieve 130-139 within 1 hour
• Early non-invasive CTA/MRA within 48 hrs

Decompressive craniotomy

Question 10

What is DSA and its use?

Answer 10

Dye is injected into cerebral vessels and picked up on imaging so that any areas of concern can be identified.

Used to get a deeper anatomical understanding of where the ICH is over CTA