Intracerebral Hemorrhage

• 15% of nontraumatic due to anticoagulation
• Etiology:
• Hypertension
• younger than thrombotic stroke
• often due to Charcot aneurysms or lipohyalinosis
• common locations include putamen, thalamus, pons, dentate, subcortical white matter
• Common in patients with longstanding, poorly controlled HTN
• Amyloid – usually elderly adults (except familial form in Netherlands/Iceland); contractile tissue replaced by amyloid beta; associated with Down syndrome, alcoholism, prion disease
• Occur in the elderly and tend to be lobar
• Vessel walls are infiltrated with amyloid deposits and intraoperative bleeding can be difficult to control
• Drugs – especially anticoagulation
• often associated aneurysms or AVM
• cocaine alters platelet aggregation, amphetamines cause vasculitis
• Sympathomimetic agents can produce hypertension
• AVM rupture – tend to occur in younger patients
• Hemorrhagic infarction
• Hemorrhage into tumor
• Renal cell carcinoma, choriocarcinoma and melanoma are most frequent metastases that hemorrhage
• Primary CNS tumors are rarely hemorrhagic
• Clinical Presentation: sudden HA, change in LOC, hemiparesis
• Diagnosis: Uncontrasted heat CT shows hemorrhage
• Contrast is given if tumor is suspected underlying etiology
• Treatment:
• ICU admission
• Strict BP control with A-line placement
• Nipride or NTG drip to keep SBP 160-180
• Don’t overtreat HTN – normal BP’s for us may hypoperfuse a long-term hypertensive patient
• Start po/NG agents once HTN well controlled and wean drip
• Generally not a surgical disease unless marked shift with a non-dominant hemisphere clot
• May rupture into ventricular system causing hydrocephalus requiring ventriculostomy