intracerebral haemorrhage

INTRACEREBRAL HAEMORRHAGE

•SUPRAENTORIAL(LOBAR,BASAL GANGLIA •INFRATENTORIAL(CEREBELLUM,PONS,BRAINSTEM)

INCIDENCE 15 TO35 PER 100,000SURVIVAL 38% IN Good Working Conditions

RISK FACTORS

•AGE•SEX•BLOOD PRESSURE•ALCOHOL CONSUMPTION•CHOLESTEROL LEVELS----LOW LEVELS(Arachidonic Acid)

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

LOCATION

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

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

CLINICAL FEATURES

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

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

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

SURGICAL THERAPEUTICS

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