Hemorrhage within the intracranial cavity could also be intracerebral, subarachnoid or intraventricular. Hypertension is the most common reason behind intracranial hemorrhage, adopted by ruptured aneurysms, and vascular malformations. Hemorrhage could consequence from bleeding problems or inflammatory illness of the cerebral arteries however it’s much less widespread.
Hypertensive intracerebral hemorrhage
Elevated blood pressure produces intracerebral hemorrhage. Not often the blood pressure could also be within the regular vary when first examined after the stroke. The extravasated blood accumulates to type a round or oval mass and behaves like an area occupying lesion displacing the mid-line buildings to the alternative aspect. The widespread websites of hypertensive hemorrhage within the order of frequency are:
1. Putamen and inside capsule
2. Central white matter,
3. thalamus
4. Cerebellum and
5. Pons
The onset is normally abrupt with fast evolution of signs. Hemorrhage typically happens whereas the affected person is up and lively. Recurrence of bleeding is uncommon. The medical indicators rely upon the situation and dimension of the hematoma. Headache is a regular grievance simply earlier than the stroke. In hemorrhage into the putamen, there’s contralateral hemiplegia changing into full inside 5-30 min. The extent of consciousness worsens progressively and the affected person lapses into coma. Higher brainstem indicators seem in massive lesions 심근경색산재.
In thalamic hemorrhage hemisensory loss equals and even out-strips the motor deficit. The attribute ocular abnormality if the skew deviation of the attention with the alternative eye deviated downward and medially. In pontine hemorrhage, the affected person is deeply comatose with pin level, however reacting pupils.
Incerebellar hemorrhage, the affected person complains of Occipital headache and repeated vomiting, adopted by vertigo and ataxia. There’s ipsilateral sixth nerve palsy with paralysis of conjugate lateral gaze to the aspect of hemorrhage.
As soon as deep stupor has supervened sufferers not often survive, Both the hemorrhage extends into the ventricles or it produces secondary brainstem compression. Dying happens in about 60-70% of instances. In these with smaller hemorrhages, the hematoma will get resolved and in these prognosis is best than that of infarction.
Analysis: With the arrival of the CT scan, localization of the location of hemorrhage has been very simple and correct, and that is the tactic of selection. Examination of the CSF for hemorrhage is just not with out hazard particularly in sufferers with raised intracranial stress. Therefore, this process is best prevented if CT is offered. In intracerebral hemorrhage, the CSF reveals quite a few erythrocytes on microscopy. The EEG could present excessive voltage gradual waves over the affected space.
Management: The fast management of an unconscious affected person with intracranial hemorrhage consists of help to air flow, fluid restriction and measures tor educe intracranial stress resembling intravenous administration of 20% mannitol or dexamethasone 4 mg/6 hours given intramuscularly.
Blood could compress mind tissue within the acute stage. Surgical evacuation of the hematoma is indicated in sufferers who should not comatose,
1. If the hemorrhage lies close to the cortex and
2. in cerebellar hematomas. In deeply comatose sufferers surgical procedure carries excessive danger. In these displaying enchancment, it might not be thought of essential. Along with the final measures instituted in comatose sufferers, correct management of hypertension can be necessary.