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INTRACEREBRAL HAEMORRHAGE

INTRACEREBRAL HAEMORRHAGE. SUPRAENTORIAL(LOBAR,BASAL GANGLIA INFRATENTORIAL(CEREBELLUM,PONS,BRAINSTEM). INCIDENCE 15 TO35 PER 100,000 SURVIVAL 38% IN Good Working Conditions. RISK FACTORS. AGE SEX BLOOD PRESSURE ALCOHOL CONSUMPTION

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INTRACEREBRAL HAEMORRHAGE

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  1. INTRACEREBRAL HAEMORRHAGE • SUPRAENTORIAL(LOBAR,BASAL GANGLIA • INFRATENTORIAL(CEREBELLUM,PONS,BRAINSTEM) INCIDENCE 15 TO35 PER 100,000 SURVIVAL 38% IN Good Working Conditions

  2. RISK FACTORS • AGE • SEX • BLOOD PRESSURE • ALCOHOL CONSUMPTION • CHOLESTEROL LEVELS----LOW LEVELS(Arachidonic Acid)

  3. AETIOLOGY PRIMARY------Chronic hypertension:degeneration in perforators and microaneurysms formation Amyloid angiopathy:medium and small sized vessels over the surface of brain SECONDARY------Aneurysms, AVM, Tumors, Coagulopthy

  4. LOCATION • LOBAR-20% • BASAL GANGLION REGION-50% • CEREBELLUM-10% • PONS-10 TO 15% • THALAMUS-15% • OTHER BRAIN STEM SITES-1 TO 6%

  5. PATHOPHYSIOLOGY • HEMATOMA AND SURROUNDING EDEMA DUE • TO EXTRAVASATED BLOOD PROTEINS OSMOTIC PRESSURE • IMBIBING WATER • VASOGENIC EDEMA-DUE TO THROMBIN FORMATION AFTER • 24 HOURS THAT DISRUPTS THE BLOOD BRAIN BARRIER • AFTER 5 DAYS LYSIS OF HAEMOGLOBIN PRODUCES FREE • RADICALS WHICH ACCOUNTS FOR THE LATEONSET OF • EDEMA

  6. CLINICAL FEATURES • SEVERE HEAD ACHE • FOCAL SIGNS • FITS • DETERIORATION OF CONSCIOUS LEVEL • DEEP COMA DUE TO HERNIATION AND RAISED • ICP

  7. RADIOLOGICAL DIAGNOSIS • CT-SCAN—TO KNOW THE DIMENSIONS AND THE VOLUME • OF HEMATOMA • CT ANGIOGRAPHY---TO LOCATE THE ANEURYSMS • AND AVM • DIGITAL SUBTRACTION ANGIOGRAPHY---SAME AS ABOVE • MRA— • MRI---TO KNOW THW DIFFERENT STAGES OF HEMATOMA

  8. MEDICAL TREATMENT • CONTROL OF BLOOD PRESSURE • CONTROL OF ICP BY OSMOTIC DIURETICS LIKE • 20% MANNITOL AND HYPERTONIC SALINE (23.4%)30ml • CORRECTION OF COAGULOPTHY BY FFP,VIT K, • PROTHROMBIN COMPLEX CONCENTRATE • ICU

  9. SURGICAL THERAPEUTICS • CRANIOTOMY---SUPRATENTORIAL HEMATOMAS THAT • ARE MORE THAN 30ml,CERBELLAR THAT • ARE MORE THAT 3CM IN SIZE • STEROTACTIC ASPIRATION • ENDOSCOPIC

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