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Published by: Mans Fans on Sep 04, 2009
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Hemorrhage into the brain

Causes of ICH

Hypertension (1ry ICH).
Vascular malformations.
Bleeding disorders.
Hemorrhage into brain tumor.
Cerebral arterial amyloidosis.
Inf. of cerebral arteries.
Hemorrhagic infarction.

Primary (hypertensive) ICH

-The commonest type.

-Due to chronic hypertension & degeneration
of cerebral arterites.
-The extravasated blood forms a mass that
disrupts and compresses the brain tissue.
-When the RAS & respiratory center are
compromised, coma and even death occurs.

Sites of 1ry ICH

The putamin.
The cerebral lobes.
The thalamus.
The cerebellum.
The pons.

Clinical manifestations

Manifestations of increased intracranial
pressure: - Headache.
- Vomiting.
- Dep. level of consciousness.

- Seizures.

Manifestations related to the site of the

Putaminal hemorrhage

The commonest type.
CP varies:
- From slight hemiparesis
& dysarthria.
- To sever coma and
deceribrate rigidity.

Lobar hemorrhage

Frontal hematomas
hemiparesis more in u.l.
Parietal hematomas
sensorimotor deficit + hemianopia.
Dominant temporal hematomas
fluent aphasia.
Occipital hematomas
homonymous hemianopia.


Thalamic hemorhage

Produces hemiparesis with sever
sensory deficit.
Dominant side lesions
fluent aphasia.
Ext. into the subthalamus & high
mid brain
ocular disturbances.
Rupture into the 3rd


Cerebellar hemorhage

Sudden onset of vertigo,
headache, vomiting and
inability to stand and walk.
A triad of ipsilat. Ataxia,
gaze palsy and l.m. facial
palsy is diagnostic.
Abrupt deterioration to coma
and death may occur.

Pontine hemorhage

The classic picture:

Coma, quadriplegia, decerebrate
rigidity, opthalmoplegia, pin
point pupils, abnormalities of
respiratory rhythm hyperthermia
and death.

Rare less sever cases:

Unilat. pontine cranial nerve
affection + long tracts

Diagnosis of ICH

Clinical features:

- Acute sever rise of

bl. pr. In chronic
hypertensive patient.

- Vomiting at onset.

- Sever


- Nuchal rigidity.

- Seizures.

- Hypertensive or hgic. fundi.

Diagnosis of ICH (Cont.)

Brain CT scan: Superior to MRI.

MRI of the brain: For brainstem hge.

D) Others: Pt, ptt, platelet count, etc.

Prognosis of ICH

Immediate prognosis:

Grave (1/3 of the patients die in 1 to 30 days).

Late Prognosis:

Better restoration of function than ischemic stroke.

Treatment of ICH

Emergency care:

To prevent airway obstruction, hypoventilation and


Control of blood pressure:

Correction of bl. Pr. Is mandatory, but cautiously and slowly.

Control of intracranial pressure:

By hyperventilation, I.v. mannitol & dexamethasone

Prevention of complications:

As seizures, pneumonia, D.V.T., urosepsis, bed sores etc.

Surgical evacuation of the hematoma:

In Patient with superficial hematomas or with cerebellar hge.

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