The term spontaneous intracerebral hemorrhage refers to a brain hemorrhage that is clearly not secondary to head trauma, rupture of vascular malformation, tumor, anticoagulant therapy. High blood pressure and chronic alcoholism are the two main causes. Cerebral haemorrhage accounts for 10 to 15% of strokes. The mortality of the disease remains high and close to 40%. The treatment of cerebral hemorrhage is first and foremost medical. The indication for neurosurgical treatment is rare, and only concerns hematomas.
Pathophysiology and etiology
We speak of hematoma when the diameter of the haemorrhage is greater than 3cm (more than 20ml in volume). Intracranial hypertension can then develop. When hemorrhage is severe, it can spread into the adjacent cerebral ventricle (ventricular flood). An intracerebral hemorrhage of more than 85ml of volume is usually fatal. Health 2U Singapore
The origin of the condition is mainly chronic hypertension (67% of cases) associated or not with chronic alcoholism. A microangiopathy develops and weakens the wall of the perforating arterioles intended for the basal ganglia, the jagged nuclei of the cerebellum and the brainstem. These perforating branches of the middle cerebral artery or basilar trunk are thus at the source of the haemorrhage. This explains the characteristic localization of spontaneous cerebral haemorrhage in the thalamus, putamen, and internal capsule, brain stem and cerebellum. Sometimes the haemorrhage affects the cerebral cortex, or can invade a whole brain lobe. Haemorrhages of the basal ganglia in relation to arterial hypertension are the most frequent (85%), compared with those of the cerebellum and brainstem (10% and 5% respectively). This hemorrhagic focus is located in a strategic functional area explaining the importance of the revealing neurological deficit (proportional motor and sensory hemiplegia, cerebellar syndrome, hemiplegic coma).
The other etiologies are rarer, such as amyloid angiopathy, which results in recurrent haemorrhages, hemopathies with coagulation disorders, cerebral thrombophlebitis with haemorrhagic infarction, and hemorrhagic cerebral softening. These haemorrhages are more readily cortical or lobar.
The diagnosis of intracerebral hemorrhage
The brain scan is the necessary and sufficient test for the positive diagnosis of cerebral hemorrhage. Hyperdensity clearly shows the site and volume of bleeding. MRI and in addition, cerebral angiography is indicated to look for a cause of hemorrhage other than arterial hypertension (example: cerebral thrombophlebitis). After 65 years, in the presence of haemorrhage of the basal ganglia, and arterial hypertension, the practice of a cerebral angiography in search of a vascular malformation is considered useless. Conversely, cerebral angiography is recommended before age 55 and especially if the haemorrhage is cortical, and arterial hypertension absent. dental lab products
Evolution of intracerebral hemorrhage
In the initial phase, it is shown that hemorrhage can progress further by 10 to 20% over the first 48 hours, which may lead to a secondary aggravation of the neurological deficit. Subsequently, hemolysis reduces the density and then the volume of hemorrhage from its periphery to its center. This evolution can be followed by CT scan: a hypodensity replaces the initial hyperdensity. nlpuktraining.co.uk
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