intracerebral%20hemorrhage
INTRACEREBRAL HEMORRHAGE
Intracerebral hemorrhage is the sudden burst of blood into the brain tissue itself.
It causes sudden onset of focal neurological deficit.
The focal neurologic findings are related to the anatomic location, size and speed of development of intracerebral hemorrhage.
Neurological deficit usually progresses over a minute to an hour.
Rapid recognition and diagnosis of intracerebral hemorrhage are essential because of its frequently rapid progression.

Definition

  • Sudden onset of focal or global cerebral dysfunction
    • Focal neurologic findings are related to the anatomic location, size and speed of development of intracerebral hemorrhage (ICH)
  • Neurological deficit usually progresses over a minute to an hour
  • It is the result of a blood vessel rupture within the brain and the blood leaks out to form a hematoma
    • Accumulated blood compress, distort and disrupt surrounding brain structures

Epidemiology

  • Most common manifestation of a chronic, progressive disorder of the brain's blood vessels and affects more than 1 million people annually worldwide
  • Incidence rate in Europe and North America is estimated as between 35 and 45 cases per 100,000 of the population
    • Accounts for 10-15% incidence of strokes in Europe and North America
    • In East Asia, incidence rate of strokes caused by intracerebral hemorrhage is 30-40%

 

Etiology

  • Amyloid angiopathy
  • Arteriovenous malformation
  • Intracranial aneurysm
  • Dural venous sinus thrombosis
  • Cavernous angioma
  • Intracranial neoplasm
  • Dural arteriovenous fistula
  • Hemorrhagic transformation of cerebral infarct
  • Vasculitis

Signs and Symptoms

Adjunctive Global Symptoms

  • Nausea and vomiting 
  • Severe headache
  • Decreased consciousness or coma
  • Elevated systolic blood pressure (SBP) >220 mmHg

Rapid recognition & diagnosis of intracerebral hemorrhage (ICH) are essential because of frequent rapid progression

Risk Factors

  • History of hypertension, diabetes, hypercholesterolemia, liver or hematologic disease, cancer, dementia, and seizures
  • Medications (eg anticoagulants, antiplatelets, decongestants, antihypertensives, stimulants, sympathomimetics)
  • Recent trauma or surgery (eg carotid endarterectomy, stenting)
  • Alcohol, smoking, illicit drug use (cocaine)
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