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.

Intracerebral%20hemorrhage Signs and Symptoms

Definition

  • Sudden onset of focal or global cerebral dysfunction is manifested
    • 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
  • In 2017, among the 6.2 million deaths caused by cerebrovascular disease globally, 3 million deaths were due to ICH
    • Mortality rate was highest in East and Southeast Asia
    • Global incidence rate of stroke due to hemorrhage was 15-40%, with >15% observed more in Asia compared to developed countries in North America and Western Europe
    • Age-standardized stroke prevalence rates of ICH was high in East and Central Asia

 

Etiology

  • Cerebral amyloid angiopathy
  • Arteriovenous malformation
  • Intracranial aneurysm
  • Dural venous sinus thrombosis
  • Cavernous angioma
  • Intracranial neoplasm
  • Dural arteriovenous fistula
  • Hemorrhagic transformation of cerebral infarct
  • Vasculitis
  • Herpes simplex virus
  • Moyamoya disease
  • Septic emboli, mycotic aneurysms

Signs and Symptoms

Adjunctive Global Symptoms

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

Rapid recognition and 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
    • Chronic hypertension accounts for 56% of attributable risk for the incidence of ICH
  • 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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