Intracerebral Hemorrhage


Background
  1. Hemorrhage into the parenchyma of the brain
  2. Ottawa SAH Rule being developed
  3. Blood pressure reduction guidelines
  4. ICH represents 8-11% of acute strokes
  5. Mainstays of Management
Pathophysiology
  1. Mechanism
  2. Etiology/Risk Factors
  3. Epidemiology
Diagnostics
  1. History/Symptoms
  2. Physical Exam/Signs (specific etiologies)
  3. Labs/Tests
  4. Imaging
  5. Other Tests/Criteria
  6. Differential Diagnosis
Treatment
  1. Initial/Prep/Goals
  2. Medical/Pharmaceutical
  3. Surgical/Procedural
  4. Complications of Treatment
  5. Prevention
Disposition
  1. OR for evacuation PRN incr ICP, edema
  2. Admit all hemorrhagic CVA pts, ICU recommended; prognosis poor
  TYPE OF PATIENT ANATOMIC LOCATION CT FINDINGS COMMON CAUSE CLASSIC SYMPTOMS
Epidural Most common in young adults, rare in the elderly Potential space between skull and dura mater Biconvex, football - shaped hematoma Skull fracture with tear  of the middle meningeal artery Immediate LOC with a "lucid" period prior to deterioration (only occurs in about 20% of patients)
Subdural More risk for the elderly & alcoholics Space between dura mater and arachnoid Crescent - or sickle-shaped hematoma Acceleration - deceleration with tearing of the bridging veins Acute: Rapid LOC - lucid period possible
Chronic: Altered MS & behavior with gradual decrease in consciousness
Subarachnoid Any age group following blunt trauma. Subarachnoid Blood in the basilar cisterns & hemispheric sulci & fissures Acceleration-Deceleration w/ tearing of the subarachnoid vessels Milt to moderate TBI w/ meningeal signs & symptoms
Contusion/
intracerebral hematoma
Any age group following blunt trauma. Usually anterior temporal or posterior frontal lobe May be normal initially with delayed bleed Severe or penetrating trauma, shaken-baby syndrome Symptoms range from normal to unconscious.
Abbreviations: LOC = loss of consciousness; MS = mental state; TBI = traumatic brain injury.