Each year, approximately 37,000 to 52,400 people in the United States.
The case-fatality rate 34.6% at 7 days. 50.3% at 30 days. 59.0% at 1 year.
Intracerebral hemorrhage and accompanying edema may disrupt or compress adjacent brain tissue, leading to neurological dysfunction.
INCIDENCE & MORTALITY:
INTRODUCTION
Intracranial hemorrhage (ie, the pathological accumulation of blood within the cranial vault) may occur within brain parenchyma.
Intracerebral hemorrhage accounts for 8-13% of all strokes.
LABORATORY STUDIES
Complete blood count (CBC) with platelets
Prothrombin time (PT)/activated partial thromboplastin time (aPTT): Identify a coagulopathy.
Alteration in level of consciousness (approximately 50%)
Nausea and vomiting (approximately 40-50%) Headache (approximately 40%) Seizures (approximately 6-7%) Focal neurological deficits Lobar hemorrhage due to cerebral amyloid
angiopathy may be preceded by prodromal symptoms of focal numbness, tingling, or weakness.
HERNIATION SYNDROMES
Displacement of structures with resulting compression of tissue and blood flow
evidence.
Subcortical/ lobar: 20 %
LOCATIONS
Putamen 40-50 %
Thalamus 15 %
Pons 8%
Cerebellum 8%
CLINICAL MANIFESTION
Onset of symptoms of intracerebral hemorrhage is usually during daytime activity, with progressive (ie, minutes to hours) development of the following:
(Stroke. 2009;40:00-00)
RISK FACTORS:
Hypertension- 60-70 %.
Cerebral Amyloid Angiopathy- 15 %.
Heavy alcohol consumption. Hypercholesterolemia. Anemia. Smoking/anti-platelet agents >> merging
Toxicology screen and serum alcohol level if illicit drug use or excessive alcohol intake is suspected
ቤተ መጻሕፍቲ ባይዱ
IMAGING STUDIES
CT scan CT scan readily demonstrates acute
Systemic Effects Hypoxia Hypercarbia Hypotension Electrolyte
imbalance Anemia/old blood Hyperthermia
Intracranial Effects Secondary impact Edema Delayed ICH Hyperemia Vasospasm Seizures
1. Uncal 2. Central 3. Cingulate 4. Transcalvarial 5. Upward 6. Tonsillar
Smith, Julian; Joe J. Tjandra; Gordon J. A. Clunie; Kaye, Andrew H. (2006).
POTENTIAL SECONDARY BRAIN INJURY
Serum chemistries including electrolytes and osmolarity: Assess for metabolic derangements, such as hyponatremia, and monitor osmolarity for guidance of osmotic diuresis.
hemorrhage as hyperdense signal intensity.
Hematoma volume in cubic centimeters can be approximated by a modified ellipsoid equation: (A x B x C)/2, where A, B, and C represent the longest linear dimensions in centimeters of the hematoma in each orthogonal plane.