Intracerebral hemorrhage is an intracranial
bleed within the brain tissue or ventricles.
Subarachnoid aneurysm causes about 50% of all
ICH.
Amyloid deposition can lead to ICH in elderly
patients.
Hypertension is another common cause of
atraumatic ICH, commonly leading to pontine, cerebellar, or basal
ganglial bleeding. Bleeding in other locations is suggestive of a
different etiology.
ICH
will often present with depressed mental status, but specifically a
patient with a systolic BP > 220 is suggestive of hypertensive
ICH.
CT is
the first diagnostic step. CTA should be considered when the
bleeding is in an atypical area. Significant edema on imaging can
be suggestive of a tumor.
Treatment should include hemostatic measures
and BP control. Transfuse platelets if necessary and reverse any
anticoagulation. BP target is <140 systolic. Monitor ICP if
patient has AMS. Neurosurgical intervention is indicated when there
is significant expansion of the hematoma with AMS or if the bleed
is cerebellar.
References:Sahni R, Weinberger J. Management of
intracerebral hemorrhage.Vascular Health and Risk
Management.
2007;3(5):701-709.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291314/
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