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Cerebral Hemorrhage


Presentation

  • Abstract The authors present a case of an infant boy, otherwise healthy, who presented with acute irritability and obtundation. A head computed tomography scan revealed massive intracerebral hemorrhage.[ncbi.nlm.nih.gov]
  • Recommendations for various surgical approaches for treatment of spontaneous intracerebral hemorrhage are presented. Finally, withdrawal-of-care and end-of-life issues in patients with intracerebral hemorrhage are examined.[ncbi.nlm.nih.gov]
  • Meanwhile, some patients with cancer also could present cerebral hemorrhage as the initial manifestation, and further studies are required to determine whether these patients have their unique clinical features.[ncbi.nlm.nih.gov]
  • In this article, we describe a case involving a multiparous woman at 34 weeks gestation who presented with a 5-cm intracerebral bleed. Within 2 hours of presenting, she underwent an emergency cesarean and craniotomy to remove the hematoma.[ncbi.nlm.nih.gov]
  • 2 h prior to presentation.[ncbi.nlm.nih.gov]
Weakness
  • Gait instability and left-side weakness developed abruptly 2 weeks later; brain magnetic resonance imaging revealed a hematoma over the right parietal-occipital lobe. Ceftriaxone was adjusted to 2 g every 12 hours.[ncbi.nlm.nih.gov]
  • However, the previous studies on MIT have focused on laboratory models and rarely on in vivo applications because the induced signals produced by biological tissues are notably weak.[ncbi.nlm.nih.gov]
  • Symptoms include sudden tingling, weakness, numbness, paralysis, severe headache, difficulty with swallowing or vision, loss of balance or coordination, difficulty understanding, speaking , reading, or writing, and a change in level of consciousness or[my.clevelandclinic.org]
  • Sharon was taken by ambulance Wednesday to the hospital after complaining of chest pain and weakness, said Ra'anan Gissin, his senior adviser. He was conscious when he arrived at the hospital, Gissin said.[cnn.com]
Swelling
  • Her both adrenal glands were severe swelling, and their parenchyma was occupied by a dark red-brown tumorous positive for chromogranin A. The serum catecholamine and their metabolite, vanillylmandelic acid (VMA) levels were markedly high.[ncbi.nlm.nih.gov]
  • A type of stroke, it causes bleeding in the surrounding tissues when the rupture occurs which leads to swelling.[gwinnettmedicalgroup.com]
  • This gives the brain space to swell without causing further damage. While this procedure improves the chances of survival for most patients, severe swelling may still result in long term deficits, or even death.[snc.md]
  • This is a weakening in a blood vessel wall that swells. The thin walls of an aneurysm can burst and cause bleeding into the subarachnoid space and the brain, leading to hemorrhagic stroke. Hypertension.[web.archive.org]
Fever
  • We report the case of a 56-year-old man with recently diagnosed HIV infection who presented with subacute mental status changes, fever, and temporal lobe abnormalities evident on brain imaging.[ncbi.nlm.nih.gov]
  • Abstract A 60-year-old woman presented with a high fever (39 C or higher). Transthoracic echocardiography revealed a large and mobile vegetation on the anterior mitral leaflet with moderate mitral regurgitation.[ncbi.nlm.nih.gov]
  • She presented with acute deterioration of consciousness and fever and was diagnosed with HSE based on the detection of herpes simplex virus-1 in the cerebrospinal fluid by a polymerase chain reaction.[ncbi.nlm.nih.gov]
  • Abstract A 53-year-old woman was admitted due to akinetic mutism and fever. On admission, brain computed tomography (CT) scan revealed a large hemorrhagic lesion in the left anterior lobe that required surgical operation for total removal.[ncbi.nlm.nih.gov]
  • She consulted our hospital because of a fever and was diagnosed with IE and a cerebral hemorrhage. A blood culture test on admission revealed methicillin-sensitive Staphylococcus aureus.[ncbi.nlm.nih.gov]
High Fever
  • Abstract A 60-year-old woman presented with a high fever (39 C or higher). Transthoracic echocardiography revealed a large and mobile vegetation on the anterior mitral leaflet with moderate mitral regurgitation.[ncbi.nlm.nih.gov]
Cheyne-Stokes Respiration
  • Sometimes there is the Cheyne-Stoke respiration. There is usually complete relaxation on the paralyzed side, though there may be twitching of the muscles or slight convulsive movements for a time.[henriettes-herb.com]
Vomiting
  • A 44-year-old male with severe hemophilia B was referred to our department because of nausea, vomiting, left lower limb hemiplegia, and left arm paresis. Computed tomography (CT) revealed a right frontal intraparenchymal bleed.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Internal Medicine, Regions Hospital, 640 Jackson Street, Saint Paul, MN 55129, USA. iqthink@yahoo.com Abstract A 53 year old female with ESRD on hemodialysis presented with headache, vomiting, and lethargy that had started[ncbi.nlm.nih.gov]
  • […] symptoms of bleeding inside the skull tend to come on rapidly and include the following: A sudden headache Steadily increasing neurologic losses, such as weakness, inability to move (paralysis), numbness, loss of speech or vision and confusion Nausea and vomiting[web.archive.org]
  • The symptoms of intracerebral haemorrhage include a headache, nausea and vomiting, alertness changes, deficiencies in verbal skills, balance, swallowing, coordination, and focusing the eyes.[psychology.wikia.com]
  • Symptoms The symptoms of intracerebral hemorrhage can include sudden, severe headache, especially with vomiting or and sleepiness, weakness of one side of the body, slurred speech, new onset of seizure, or loss of consciousness after one of the above[hopkinsmedicine.org]
Nausea
  • A 44-year-old male with severe hemophilia B was referred to our department because of nausea, vomiting, left lower limb hemiplegia, and left arm paresis. Computed tomography (CT) revealed a right frontal intraparenchymal bleed.[ncbi.nlm.nih.gov]
  • Medical Definition of cerebral hemorrhage : bleeding from a ruptured blood vessel in the brain and especially in the cerebrum that is often life-threatening and is marked by sudden headache, nausea, impaired consciousness, and neurological dysfunction[merriam-webster.com]
  • Symptoms The symptoms of bleeding inside the skull tend to come on rapidly and include the following: A sudden headache Steadily increasing neurologic losses, such as weakness, inability to move (paralysis), numbness, loss of speech or vision and confusion Nausea[web.archive.org]
  • Nausea, vomiting, delirium, and focal or generalized seizures are also common. Neurologic deficits are usually sudden and progressive.[merckmanuals.com]
  • Symptoms, which typically come on suddenly, may include: Sudden severe headache with no known cause Increasing neurologic problems such as numbness, weakness, inability to move (paralysis) loss of speech or vision and confusion Seizures Vomiting or severe nausea[wellstar.org]
Stroke
  • BACKGROUND: The relationship between uric acid and stroke prognosis is ambiguous. Some studies have explored this relationship in acute stroke but have different results.[ncbi.nlm.nih.gov]
  • MATERIAL AND METHODS: We reviewed all stroke patients registered in the Kyoto Stroke Registry (from January 1999 to December 2009) in Japan.[ncbi.nlm.nih.gov]
  • , but none of the SNPs tested had an association with ischemic stroke.[ncbi.nlm.nih.gov]
  • METHODS: There were 1280 stroke patients (1101 with ischemic stroke and 179 with cerebral hemorrhage) and 1380 controls in the study.[ncbi.nlm.nih.gov]
  • stroke. 2015 World Stroke Organization.[ncbi.nlm.nih.gov]
Headache
  • Thereafter, her mental status markedly improved and her headache resolved.[ncbi.nlm.nih.gov]
  • With intracerebral hemorrhage, sudden, severe symptoms (eg, sudden headache, loss of consciousness, vomiting) are common, but headache may be absent (particularly in the elderly), and small hemorrhages may mimic ischemic stroke.[merckmanuals.com]
  • On day 340, the patient suddenly complained of severe headache. Computed tomography confirmed subcortical hemorrhage, and he died on day 348.[ncbi.nlm.nih.gov]
  • CLINICAL CASE: We present the case of a 19-year-old male who came to the Emergency Department complaining of intense headache of abrupt onset. His physical examination revealed a striking increase in size of the right testicle of tumoral origin.[ncbi.nlm.nih.gov]
  • Medical Definition of cerebral hemorrhage : bleeding from a ruptured blood vessel in the brain and especially in the cerebrum that is often life-threatening and is marked by sudden headache, nausea, impaired consciousness, and neurological dysfunction[merriam-webster.com]
Confusion
  • He was not confused. He suffered from a certain difficulty in speaking. A small blood clot briefly blocked a blood vessel in his brain," the doctor said.[cnn.com]
  • December 01, 1993 ; 43 (12) Articles First published December 1, 1993, DOI: Abstract Sudden headache, confusion, and hemiparesis followed within minutes of late-morning sexual intercourse in a 39-year-old man.[n.neurology.org]
  • They include headache, weakness, confusion, and paralysis, particularly on one side of your body. The buildup of blood puts pressure on your brain and interferes with its oxygen supply. This can quickly cause brain and nerve damage.[healthline.com]
  • Symptoms The symptoms of bleeding inside the skull tend to come on rapidly and include the following: A sudden headache Steadily increasing neurologic losses, such as weakness, inability to move (paralysis), numbness, loss of speech or vision and confusion[web.archive.org]
  • Increasing headache Vomiting Drowsiness and progressive loss of consciousness Dizziness Confusion Unequal pupil size Weak limbs on one side of your body Increased blood pressure Seizures Symptoms may show more gradually over a period of weeks, but if[gwinnettmedicalgroup.com]
Stupor
  • […] tingling, weakness, numbness, paralysis, severe headache, difficulty with swallowing or vision, loss of balance or coordination, difficulty understanding, speaking , reading, or writing, and a change in level of consciousness or alertness, marked by stupor[my.clevelandclinic.org]
  • Symptoms can include: Abnormal sense of taste Change in alertness (level of consciousness) Apathetic, withdrawn Sleepy, lethargic, stuporous Unconscious, comatose Difficulty speaking or understanding speech Difficulty swallowing Difficulty writing or[snc.md]
  • […] particularly on one side of the body Difficulty with swallowing or vision Loss of balance or coordination Difficulty understanding, speaking (slurring nonsensical speech), reading or writing Change in level of consciousness or alertness, marked by lethargy, stupor[livescience.com]
  • Other brain hemorrhage symptoms include: sudden, severe headache difficulty swallowing problems with vision loss of balance or coordination confusion or difficulty understanding difficulty talking or slurred speech stupor, lethargy, or unconsciousness[medicalnewstoday.com]
Dysarthria
  • During the course of illness, the patient had an acute cerebral hemorrhage, which manifested with hemiparesis, dysarthria, and pathologic crying. Review of the literature revealed 15 cases of primary brain amyloidoma.[ncbi.nlm.nih.gov]
  • He had fluent speech with a mild dysarthria and left facial droop. His sensation was intact and motor strength were intact except for persistent right sided weakness.[thoracic.org]
  • Focal Lesions If focal lesions affect the language and swallowing centers of the brain, they can cause symptoms similar to those seen as a result of a left cerebral vascular accident including apraxia, dysarthria, aphasia, dysphagia, agnosia, anomia,[web.archive.org]

Workup

  • Every patient undergoes a thorough, individualized diagnostic workup with advanced imaging technologies to determine the underlying cause of the stroke.[uabmedicine.org]
  • Nontraumatic Acute Intraparenchymal Hemorrhage: Algorithm for Workup and Differential Diagnosis . Seminars in Roentgenology, Vol. 49, Issue. 1, p. 112. CrossRef Google Scholar Aviv, Richard I. Kelly, Adam G. Jahromi, Babak S. Benesch, Curtis G.[doi.org]
Xanthochromia
  • Lumbar puncture: should be performed on any patient with suspected SAH and a negative CT head, xanthochromia can be seen within 12 hours of ictus and can last for 2 weeks afterwards.[clinicaladvisor.com]
Brain Edema
  • By releasing their cytoplasmic granules, which contain a host of vasoactive mediators such as tumor necrosis factor- α, histamine, heparin, and proteases, MCs act on the basal membrane, thus promoting blood–brain barrier (BBB) damage, brain edema, prolonged[web.archive.org]
  • Pathogenesis of brain edema and investigation into anti-edema drugs. Int J Mol Sci 2015; 16 (05) 9949-9975 58 Yamaguchi S, Kobayashi S, Yamashita K, Kitani M. Pial arterial pressure contribution to early ischemic brain edema.[doi.org]
  • When significant brain edema is present, it causes an increase in the tissue component of the total intracranial volume and results in decreased compliance and increased ICP.[web.archive.org]
  • Maintain euvolemia, using normotonic rather than hypotonic fluids, to maintain brain perfusion without exacerbating brain edema. Avoid hyperthermia.[emedicine.medscape.com]

Treatment

  • There were no differences across the treatments in the incidence rates of 3-month mortality, early neurological deterioration, hypotension, and treatment-related adverse effects other than renal events.[ncbi.nlm.nih.gov]
  • RESULTS: The overall effective rates of the treatment (86.3%) and control (75.0%) groups differed significantly (p 0.05) before treatment significantly decreased (p CONCLUSION: Combined minimally invasive hematoma evacuation and edaravone effectively[ncbi.nlm.nih.gov]
  • Death rates were similar between patients randomized to intensive BP-lowering treatment and those receiving guideline BP-lowering treatment (odds ratio 1.01, 95% confidence interval: 0.83-1.23; p 0.914).[ncbi.nlm.nih.gov]
  • These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.[ncbi.nlm.nih.gov]
  • Recommendations for various surgical approaches for treatment of spontaneous intracerebral hemorrhage are presented. Finally, withdrawal-of-care and end-of-life issues in patients with intracerebral hemorrhage are examined.[ncbi.nlm.nih.gov]

Prognosis

  • Alpha-frequency coma (AC) is a rare finding in comatose patients and is generally associated with a poor prognosis.[ncbi.nlm.nih.gov]
  • BACKGROUND AND PURPOSE: Intraventricular hemorrhage (IVH) with spontaneous intracerebral hemorrhage indicates a poor prognosis but uncertainty exists over the pattern of association.[ncbi.nlm.nih.gov]
  • BACKGROUND: The prognosis in acute spontaneous intracerebral hemorrhage (ICH) is related to hematoma volume, where 30 mL is commonly used to define large ICH as a threshold for neurosurgical decompression but without clear supporting evidence.[ncbi.nlm.nih.gov]
  • OBJECTIVE: The objective of the present study was to determine the correlation between blood calcium level, hematoma volume and stroke severity in the prognosis of acute cerebral hemorrhage patients.[ncbi.nlm.nih.gov]
  • Proportion of patients with good prognosis (ADL I-III) was larger in the keyhole group (P 0.05).[ncbi.nlm.nih.gov]

Etiology

  • Investigations of the etiology revealed abnormal clotting times and reduced activity of all vitamin K-dependent factors. All etiologies of vitamin K deficiency were ruled out except malabsorption.[ncbi.nlm.nih.gov]
  • The etiology of the intracerebral hemorrhage immediately after carotid stenting might be analogous to that of hypertensive hemorrhage.[ncbi.nlm.nih.gov]
  • In conclusion, even though the patient's presentation appears to be a tako-tsubo syndrome, the radiographic evidence of a cerebral hemorrhage presents as a stronger etiology for the cardiac changes that occur in our patient.[ncbi.nlm.nih.gov]
  • The etiology, epidemiology, treatment and prognosis vary widely depending on the type of hemorrhage, and as such these are discussed separately.[radiopaedia.org]
  • Although a cardiac tumor is a rare cause of a cerebral hemorrhage, a cardiac evaluation is recommended in pediatric patients with a cerebral hemorrhage of unknown etiology.[ncbi.nlm.nih.gov]

Epidemiology

  • As this disease has no unique characteristics at first presentation such as epidemiology and obvious clinical manifestation, a diagnosis of CNS TB remains difficult.[ncbi.nlm.nih.gov]
  • The etiology, epidemiology, treatment and prognosis vary widely depending on the type of hemorrhage, and as such these are discussed separately.[radiopaedia.org]
  • Summary Epidemiology The prevalence is unknown. HCHWA has been described in several families from all over the world. The estimated number of affected patients is between 300 and 400.[orpha.net]
  • .), and Epidemiology and Public Health (L.M.B.), Yale University School of Medicine, New Haven, Conn; Stroke Program (L.B.M.), University of Michigan, Ann Arbor; Mayo Medical School (T.B.), Rochester, Minn; and Case Western Reserve University School of[web.archive.org]
Sex distribution
Age distribution

Pathophysiology

  • Despite the high morbidity and mortality associated with ICH, its pathophysiology has not been investigated as well as that of ischemic stroke.[ncbi.nlm.nih.gov]
  • BACKGROUND AND PURPOSE: The effect of obesity on the risk of intracerebral hemorrhage (ICH) may depend on the pathophysiology of vessel damage.[ncbi.nlm.nih.gov]
  • The underlying pathophysiology of cerebrovascular complications during bacterial meningitis (infarct, venous thrombosis and hemorrhages) is largely unknown but may share common pathophysiological mechanisms: first, there is a dysregulation of both the[journals.plos.org]
  • Pathophysiology Edit Blood carries plasma proteins, leukocytes and other molecules which damage brain cells when they flood the area.[psychology.wikia.com]
  • Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation 2008; 118 (02) 176-187 11 Hong KS. Blood pressure management for stroke prevention and in acute stroke.[doi.org]

Prevention

  • Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations[ncbi.nlm.nih.gov]
  • DISCUSSION: PreventIon of CArdiovascular events in iSchemic Stroke patients with high risk of cerebral hemOrrhage is the largest secondary stroke prevention trial for informing antiplatelet therapy and lipid management in patients at high risk of haemorrhagic[ncbi.nlm.nih.gov]
  • Cerebral hemorrhage tended to occur less frequently after STA-MCA anastomosis, and bypass surgery was suggested to have some beneficial effect in preventing cerebral hemorrhage in adult moyamoya disease.[ncbi.nlm.nih.gov]
  • The prevention of dementia and preserving cognitive function are also important in stroke patients, but its strategy is not established yet.[ncbi.nlm.nih.gov]
  • Prevention is also necessary for people who are at higher risk of developing cerebral hemorrhage. Cerebral Hemorrhage - Prevention Prevention is the best cure and this rule applies on prevention of cerebral hemorrhage as well.[ic.steadyhealth.com]

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