Intracerebral Haemorrhage

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

422

Pages:

5
Author:

Mariam A. A.

Intracerebral Haemorrhage Definition Bleeding within brain parenchyma Epidemiology Most commonly affects deep structure of the brain Causes Traumatic Non-traumatic HTN Most common AV malformations Vasculitis E.g. giant cell arteritis Injury Neoplasms E.g. meningioma Ischemic stroke Haemorrhagic transformation Septic emboli Coagulopathy Locations Basal ganglia Most common Thalamus Cerebral lobes Pons Brainstem Cerebellum Classifications Type Description Putamen Thalamus Deep ICH (most common) Internal capsule Brainstem Lobar ICH Cortical-subcortical white matter Intraventricular extension Ruptures into the ventricles Clinical features Course progress gradually minutes to few hours Headache Not present in small haemorrhages Most common in cerebellar and lobar haemorrhages Focal neurological signs Depend on location C/L hemiparesis or hemiplegia Aphasia Sensory loss or muscle weakness Features of increased ICP – late Nausea Vomit Confusion and LOC Fixed pupils Not reactive to light Bradycardia No cough reflex Due to CN deficits Investigations Within first 1 hr Coagulation studies CBC to rule out thrombocytopenia Glucose CT without contrast MRI head Hours to days U&E, Cr, serum glucose Cardiac troponins CT angiography MRI angiography (alternative to CT) CT or MRI venography if venous involvement is suspected If there is a strong suspicion for an underlying structural lesion cerebral angiography Management Most can be managed with conservative management ABCDE Same as SAH Correct of coagulopathies Warfarin + vit K DOACs Management of cerebral oedema Medical Salty 3% HTS or 23.4% HTS Mannitol Surgical Decompressive craniotomy EVD Blood evacuation Detection and management of complications Dysphagia NPO until assessed for dysphagia Clinical swallow test Seizures Continuous EEG monitoring Avoid prophylactic anticonvulsants Cardiac Serial ECG Electrolyte abnormalities VTE Surgical management Hematoma evacuation recommended when: Large hematoma more than 3 cm Hydrocephalus Features of brain herniation Declining neurological status Decompressive craniotomy May be done alone or in combo with hematoma evacuation Vascular embolization E.g. for AVMs Complications Elevated ICP brain herniation Recurrent haemorrhage Dysphagia Seizures SIADH DVT Hydrocephalus Vasospasm and cerebral ischemia Prevention Same as stroke prevention DDx Cerebral amyloid angiopathy Vascular malformation Cerebral venous thrombosis Reversible cerebral vasoconstriction syndrome Intracranial aneurysm