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Spontaneous parenchymal cerebral hemorrhage overview

Published: April 03, 2010. Updated: April 03, 2010

 

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Intracerebral hemorrhage can cause neurological deficit due to the pressure of the escaping blood on the surrounding tissue.

Causes

Intracerebral Hemorrhage (brain hemorrhage) is an important cause of stroke, especially in Asians and blacks. Hypertension, trauma, and cerebral amyloid angiopathy cause the majority of these hemorrhages.

Hypertensive parenchymal hemorrhage (hypertensive hemorrhage or hypertensive intracerebral hemorrhage) usually results from spontaneous rupture of a small penetrating artery deep in the brain. The most common sites are the basal ganglia (putamen, thalamus, and adjacent deep white matter), deep cerebellum, and pons.

Cerebral amyloid angiopathy is a disease of the elderly in which arteriolar degeneration occurs and amyloid is deposited in the walls of the cerebral arteries but not elsewhere. Amyloid angiopathy causes both single and recurrent lobar hemorrhages and is probably the most common cause of lobar hemorrhage in the elderly.

Cocaine-induced stroke is an important cause of stroke, particularly in patients<40.

Head injury often causes intracranial bleeding. The common sites are intracerebral (especially temporal and inferior frontal lobes) and into the subarachnoid, subdural, and epidural spaces.

Intracranial hemorrhages associated with anticoagulant therapy can occur at any location; they are often lobar or subdural.

Hemorrhage into a brain tumor may be the first manifestation of neoplasm.

Hypertensive encephalopathy is a complication of malignant hypertension.

Primary intraventricular hemorrhage is rare.

Pathophysiology

The expanded volume increases intracranial pressure and puts pressure directly on cerebral cells and vessels. The formation of a clot further increase the pressure, decreasing the blood supply and oxygen content available to cerebral tissue leading to cellular anoxia and cell death. Precipitating factors include vascular malformations, aneurysm, trauma, hypertension and clotting disorders.

Types of intracerebral hemorrage

1. Subarachnoid hemorrhage (around the brain):

Subarachnoid hemorrhage (SAH) may be due to aneurysm rupture (most common), vascular malformation, brain tumors or blood dyscrasias.

Symptoms include sudden onset of the “worst headache in life”, nuchal rigidity, photophobia, nausea, vomiting, seizures, and decreasing level of consciousness. Many of the symptoms are similar to meningitis and these two conditions must be differentiated. CSF is contains excess blood.

2. Intracerebral (in the brain substance):

Intercerebral hemorrhage refers to bleeding within the brain tissue.

Symptoms develop suddenly with gradual worsening - decreasing level of consciousness, nuchal (neck) rigidity, photophobia, motor-sensory deficit of face, arms and legs.

Diagnosis

A CAT scan can easily diagnose the condition.

Treatment

Is mainly symptomatic as well as treatment of the underlying condition. Hypertension shoudl be treated to high normal blood pressure levels.

Dehydrating measures are used to decrease brain edema.

If the CAT scan shows that the cerebellar hemorrhage is compressing the brain stem or causing hydrcephalus then surgical interventions which include lateral ventricle decompression, clot removal or posterior fossa decompression is indicated.
* the outcome of lobar hemorrhage is better than the others as the blood dissects between tissue rather than destroying it.


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