Intracranial Hemorrhage



Figure 13-1
Hypertensive hemorrhage: A 47-year-old male with hypertensive urgency – large, acute hematoma in the right basal ganglia with mild perilesional edema causing mass effect, midline shift, and subfalcine herniation (Images courtesy of Dr. Ajay Malhotra)



A330798_1_En_13_Fig2_HTML.gif


Figure 13-2
A 64-year-old hypertensive female with acute headache and sensory symptoms: Left thalamic bleed which increased in size on the 6 h follow-up scan with intraventricular extension and blood layering in the left occipital horn. MRI showing features of acute bleed, isointense on T1 WI, hypointense signal on T2 WI, absence of contrast enhancement, and “blooming” on SWI (Images courtesy of Dr. Ajay Malhotra)




  • HTN : accounts for 60–70 % of all primary ICH (Fig. 13-1)



    • Leads to degeneration, fibrinoid necrosis, lipohyalinosis, Charcot–Bouchard aneurysms, and rupture of small penetrating arteries


    • Most common locations for HTN bleed: basal ganglia (especially putamen), thalamus, pons, cerebellum, deep white matter


  • Cerebral Amyloid Angiopathy :



    • 15 % of all primary ICH cases


    • Deposits of beta-amyloid protein in small and medium-sized blood vessels


    • Typically present as large spontaneous lobar hemorrhages


    • More common in elderly


    • Annual risk of recurrence: 11 %


    • Presence of e2 and e4 allele triples risk of hemorrhagic recurrence


    • Race: higher incidence in Asian and black ethnicity



  • Secondary Hemorrhage (Table 13-1)


    Table 13-1
    Secondary sources of ICH
































    Secondary sources of ICH

    Intracranial aneurysm

    Cavernous malformation

    Arteriovenous malformation

    Vasculitis

    Dural arteriovenous fistula

    Dural sinus thrombosis

    Anticoagulant use

    Hemorrhagic conversion of ischemic stroke

    Coagulopathies

    Endocarditis

    Drug use

    Tumor




    • Vascular malformations: arteriovenous malformations , intracranial aneurysms , cavernomas (discussed in greater detail in the following chapter)


    • Coagulopathies



      • Patients treated with OACs account for 12–14 % of ICH cases


      • Most HTN- related hemorrhages develop over first few hours, whereas coagulopathy-related hemorrhages known to evolve for 24–48 h


      • Rate of occurrence in the anticoagulated population: 0.2–1.0 % per year


      • Warfarin- related ICH:



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    Oct 7, 2017 | Posted by in NEUROLOGY | Comments Off on Intracranial Hemorrhage

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