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Hypertensive intracerebral hemorrhage

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Hypertensive intracerebral hemorrhage Powered By Docstoc
					Intracerebral Hemorrhage
                  Causes of ICH
   The direct cause of injury is hypertension,
    however this can be associated with a number of
    pathologic conditions.
   Such as :
       Hypertension, amyloid angiopathy, ruptured saccular
        aneurysm, vascular malformation as well as
        iatrogenic drug therapy induced bleeding which
        account for the majority of cases.
Clinical Manifestations Hypertensive ICH
   Will depend on the area of the brain that gets affected.
      Putaminal, Cerebellar, Thalamic, Lobar, and Pontine
        hemorrhages are the main hemorrhages observed.
      Extension of parenchymal bleeding of ICH into the
        ventricles is intraventricular hemorrhage [IVH]
   The neurologic symptoms usually increase gradually over
    minutes or a few hours. In contrast to brain embolism and
    subarachnoid hemorrhage, the neurologic symptoms do not
    begin abruptly and are not maximal at onset.
   Headache, vomiting, a decreased level of consciousness and
    seizures are common.
    Stupor or coma in ICH is an ominous sign of diffuse brain
    injury.
   Some patients have abnormalities on ECG, including a
    prolonged QT interval, depressed ST segment, flat or inverted T
    waves, U waves, and tall peaked T waves.
           Site-Specific Symptoms
   Putaminal hemorrhage
      Hemiplegia, hemisensory loss, homonymous hemianopsia,
       gaze palsy, stupor, and coma.
   Cerebellar hemorrhage
      Imbalance, vomiting, headache, neck stiffness, gaze palsy,
       and facial weakness. The patient may become stuporous
       from brainstem compression over time. Cerebellar
       hemorrhage is a crucial diagnosis to make since these
       patients frequently deteriorate and require surgery.
   Thalamic hemorrhage
      Hemiparesis, hemisensory loss There may also be an upgaze
       palsy with miotic pupils that are unreactive, and eyes that
       deviate to the affected side.
           Site-Specific Symptoms
   Lobar hemorrhage
      Symptoms vary considerably and injury most often
       affects the parietal and occipital lobes and are associated
       with a higher incidence of seizures.
   Pontine hemorrhage
      These often lead to deep coma over the first few
       minutes. The motor examination is marked by total
       paralysis. The pupils are pinpoint and react to a strong
       light source. Horizontal eye movements are absent, and
       there may be ocular bobbing, facial palsy, deafness, and
       dysarthria when the patient is awake.
Cerebellar Hemorrhage

 Thalamic hemorrhage

   Pontine hemorrhage

   Lobar hemorrhage

  Putaminal hemorrhage
Evaluating Intracerebral Hemorrhage
   ICH score — A simple six-point clinical grading scale
    called the ICH score has been devised to predict
    mortality after ICH
   The ICH score is determined as follows:
      Glasgow Coma Scale (GCS) score 3 to 4 (= 2
       points); GCS 5 to 12 (= 1 point) and GCS 13 to 15
       (= 0 points)
      ICH volume 30 cm3 (= 1 point), ICH volume <30
       cm3 (= 0 points)
      Intraventricular extension of hemorrhage present (=
       1 point); absent (= 0 points)
      Infratentorial origin yes (= 1 point); no (= 0 points)
      Age 80 (= 1 point); <80 (= 0 points)
   Cheung et al. (2003) validated the ICH score by
    retrospective analysis indicating it as a better
    predictor of outcome than the Glasgow coma
    scale alone.
   Thirty-day mortality rates increased steadily with
    ICH score; mortality rates for ICH scores of 1,
    2, 3, 4, and 5 were 13, 26, 72, 97, and 100
    percent, respectively. No patient with an ICH
    score of 0 died, and none had a score of 6 in the
    cohorts studied.
                 Works Cited
   Cheung, RT, Zou, LY. Use of the original,
    modified, or new intracerebral hemorrhage score
    to predict mortality and morbidity after
    intracerebral hemorrhage. Stroke 2003; 34:1717.
   www.uptodate.com
   www.emedicine.com
   www.uwo.ca/cns/resident/piclib.html

				
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