Intracerebral Haemorrhage

Question 1

What proportion of strokes are haemorrhagic?

Answer 1

15%

• Intracerebral haemorrhage (10%)
• Sub-arachnoid haemorrhage (5%)

Question 2

What are the two main types of haemorrhagic stroke?

Answer 2

Deep intra-cerebral haemorrhage

Lobar intra-cerebral haemorrhage

Question 3

Describe a deep intra-cerebral haemorrhage

Answer 3

Caused by rupture of micro-aneurysms (Charcot-Bouchard)

Occur in sub-cortical areas

Question 4

Describe a lobar intra-cerebral haemorrhage

Answer 4

Occur in normotensive individuals >60 in cerebral cortex

Can be caused by cerebral amyloid angiopathy

Question 5

What is the presentation of an intracerebral haemorrhage?

Answer 5

Same as haemorrhagic stroke
No reliable way to differentiate at bedside
-more likely to present w/ severe headache & coma

Question 6

What investigations are appropriate in suspected intracerebral haemorrhage?

Answer 6

CT (haemorrhage seen immediately)

MRI (reliable >2hrs from sx onset)

Question 7

What is the appropriate management of intracerebral haemorrhage?

Answer 7

As per cerebral infarction (antiplatelets/anticoag contraindicated)
Reverse anticoag
Lower BP to <140/90 w/i 1hr (IV betolol)
Neurosurgical intervention

Question 8

What is the immediate prognosis of intracerebral haemorrhage?

Answer 8

Worse than ischaemic stroke