Intracerebral Hemorrhages

Question 1

Cerebral amyloid Angiopathy

Answer 1

Common cause for intracranial hemorrhages (ICAs)

most common cause of lobar hemorrhages

Usually asymptomatic until the hemorrhages start

More common in small/medium sized vessels in the brain (superfical in the Brain)

Question 2

HTN induced ICH

Answer 2

Common cause of ICHs

most common risk factor

Causes small microscopic cracks in the blood vessels that eventually ruptures

More common in the putamen, thalamus and pons (deep in the brain)

Question 3

What is the cut off for platelet counts to where hemorrhages become a worry?

Answer 3

50,000

Question 4

Presentations of ICHs

Answer 4

Mostly occur during routine activity, without headaches (unless it’s subarachnoid)

Symptoms vary as well as the onset

Often present with focal neurologic defects depending on where the bleed is. Also fatigue/malaise is seen usually

Vertigo and balance is only seen in cerebellar hemorrhages

Question 5

Cerebellar hemorrhages

Answer 5

Symptoms:

• vomiting
• inability to ambulated
• content nystagmus
• ataxia
• dysmetria

must get surgery if the lesion is greater than 3cm (prevent herniation)

Question 6

Subarachnoid hemorrhages

Answer 6

Described as worst headache ever, and has super abrupt onset.

• attains maximum intensity immediately and doesnt go down
• May also show neck stiffness

high association if polycystic kidney disease and FH of cerebral aneurysms

Treat vasospasm as with nimodipine*

• can present with obstructive hydrocephalus (vomiting and acute mental status change after subarachnoid hemorrhage fix. New imaging will show enlargement of the 3rd and 4th ventricle)*