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![Clinical presentation
• Alteration in level of consciousness
(approximately 50%)
• Nausea and vomiting (approximately 40-50%)
• Headache (approximately 40%)
• Seizures[3] (approximately 6-7%)
• Focal neurological deficits](https://image.slidesharecdn.com/intracerebralhemorrhage-120906125157-phpapp02/75/Intracerebral-hemorrhage-10-2048.jpg)
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Intracerebral hemorrhage
Intracerebral hemorrhage is more common in Asian countries and incidence increases with age. It has a high mortality rate, especially when located in the brainstem. Clinical presentation includes altered mental status, headache, nausea and focal neurological deficits depending on the location of bleeding in the brain. CT scan is used to diagnose and determine the size and location of hemorrhage. Treatment focuses on controlling blood pressure, reducing ICP and treating the underlying cause.
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Intracerebral hemorrhage
- 1. Intracerebral hemorrhage Thawatchai Leelawittayanont, B. Pharm, MD
- 2. • Introduction • Etiology • Pathophysiology • Clinical presentation • Diagnosis and Imaging • Treatment
- 3.
- 4. Epidemiology • Asian countrieshave a higher incidence of intracerebral hemorrhage than other regions of the world. • A higher incidence of intracerebral hemorrhage has been noted in Chinese, Japanese, and other Asian populations, possibly due to environmental factors (eg, a diet rich in fish oils) and/or genetic factors.
- 5. Epidemiology • Annually, morethan 20,000 individuals in the United States die of intracerebral hemorrhage. • Intracerebral hemorrhage has a 30-day mortality rate of 44%. • Pontine or other brainstem intracerebral hemorrhage has a mortality rate of 75% at 24 hours. • Incidence of intracerebral hemorrhage increases in individuals older than 55 years and doubles with each decade until age 80
- 6. Etiology • Hypertensive ICH • Essential • Eclampsia • Non-hypertensive ICH – Vascular malformation: AVM, Aneurysm, Cavernous hemangioma – Bleeding disorders/anticoagulant – Amyloid angiopathy – Trauma – Tumor – Drug abuse: amphetamine, cocaine, PPA
- 7. Pathophysiology • Primary immediateeffect – Hemorrhage growth – Increase ICP • Secondary effect – Downstream effect – Edema – Ischemia
- 8.
- 9. • basal ganglia (40-50%), • lobar regions (20-50%), • thalamus (10-15%), • pons (5-12%), • cerebellum (5-10%), • other brainstem sites (1-5%).
- 10. Clinical presentation • Alterationin level of consciousness (approximately 50%) • Nausea and vomiting (approximately 40-50%) • Headache (approximately 40%) • Seizures[3] (approximately 6-7%) • Focal neurological deficits
- 11. Focal neurological deficits •Putamen - Contralateral hemiparesis, contralateral sensory loss, contralateral conjugate gaze paresis, homonymous hemianopia, aphasia, neglect, or apraxia • Thalamus - Contralateral sensory loss, contralateral hemiparesis, gaze paresis, homonymous hemianopia, miosis, aphasia, or confusion
- 12. Focal neurological deficits •Lobar - Contralateral hemiparesis or sensory loss, contralateral conjugate gaze paresis, homonymous hemianopia, abulia, aphasia, neglect, or apraxia • Caudate nucleus - Contralateral hemiparesis, contralateral conjugate gaze paresis, or confusion
- 13. Focal neurological deficits •Brain stem - Quadriparesis, facial weakness, decreased level of consciousness, gaze paresis, ocular bobbing, miosis, or autonomic instability • Cerebellum - Ataxia, usually beginning in the trunk, ipsilateral facial weakness, ipsilateral sensory loss, gaze paresis, skew deviation, miosis, or decreased level of consciousness
- 14. Investigation • Laboratory studies – CBC – Coagulogram – Electrolyte – others • Imaging – CT brain w/o contrast
- 15. CT-brain • demonstrates acutehemorrhage as hyperdense signal intensity • Multifocal hemorrhages at the frontal, temporal, or occipital poles suggest a traumatic etiology. • Hematoma volume can be approximated by (A x B x C)/2 • Iodinated contrast may be injected to increase screening yield for underlying tumor or vascular malformation.
- 16. Vessel imaging • CTangiography permits screening of large and medium-sized vessels for AVMs, vasculitis, and other arteriopathies.