Intracerebral haemorrhage Flashcards
(7 cards)
Define intracerebral haemorrhage
Sudden bleeding into brain tissue due to rupture of blood vessels, leading to infarction due to O2 deprivation. Pooling of blood increases ICP. 10% of strokes, 50%
mortality.
What are the risk factors for intracerebral haemorrhage?
- Hypertension – uncontrolled HTN is almost always the cause
- Age
- Alcohol
- Smoking
- Diabetes
- Anticoagulation/Thrombolysis
What are causes of intracerebral haemorrhages?
Anything that increases the risk of a vessel rupturing
- Hypertension - causes stiff, brittle vessels prone to rupture, microaneurysms
- 2° to ischaemic stroke - bleeding after reperfusion
- Head trauma
- AV malformations
- Vasculitis
- Vascular/Brain tumours
- Cerebral amyloid angiopathy - amyloid beta deposits in small/medium vessels
- Carotid artery dissection
What can increased intracranial pressure lead to?
- Pooling of blood puts pressure on brain
- May cause CSF obstruction - hydrocephalus
- Leading to midline shift/tentorial herniation
- Eventually coning - brain stem compression - Death
What is the clinical presentation of a intracerebral haemorrhage?
Virtually indistinguishable from ischemic infarct
- CT head needed
- More likely to lose consciousness
- More likely to have headache (usually sudden onset)
What is are the treatments for intracerebral haemorrhage?
- Coagulation -
- Stop anticoagulants immediately
- Reverse with clotting factor replacement if needed (Beriplex + vitamin k if on warfarin) - BP control
- Reducing ICP -
IV mannitol
Mechanical ventilation if needed - Neurosurgical referral -
Decompression/shunting may be required
How is BP controlled for the treatment of intracerebral haemorrhage?
- Consider rapid BP lowering if <6 hours before onset and systolic BP is between 150-220
mmHg - Aim to lower below 140 mmHg systolic
- Contraindicated: underlying structural cause, GCS below 6, early neurosurgery, poor
prognosis
