Presentation
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]
Entire Body System
- Weakness
Other causes of hemorrhage include aneurysm -- a weak spot in the wall of an artery -- which then balloons out and may break open. [medicinenet.com]
Others experience warning symptoms such as sudden and intense headache, nausea, vomiting, quick onset of numbness or weakness, dizziness, or loss of consciousness. [mountsinai.org]
- Swelling
Surgery may be needed to alleviate swelling and prevent bleeding. Certain medications may also be prescribed. These include painkillers, corticosteroids, or diuretics to reduce swelling, and anticonvulsants to control seizures. [webmd.com]
The patient visited our emergency department with gait disturbance, pain and swelling in his right leg. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed intramuscular hematoma and intracranial hemorrhage. [ncbi.nlm.nih.gov]
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]
A type of stroke, it causes bleeding in the surrounding tissues when the rupture occurs which leads to swelling. [gwinnettmedicalgroup.com]
- Fever
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]
- High Fever
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]
Clinical manifestations following acute cerebral hemorrhage can be brain edema, intracranial hypertension, high fever, cerebral hernia, limb and speech disorder, breathing and heartbeat inhibition, shock and even death have been reported [3]. [oatext.com]
Respiratoric
- 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]
Cheyne-Stokes respirations are characterized by periods of breathing with fluctuating tidal volumes and periods of apnea. [emsworld.com]
Gastrointestinal
- Vomiting
Prominent nausea and vomiting in the setting of any focal neurologic deficit suggest the possibility of accompanying increased intracranial pressure, as often occurs with ICH. Of all the hypertensive ICH locations, it is the least common. [casemed.case.edu]
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]
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]
Nausea, vomiting, delirium, and focal or generalized seizures are also common. Neurologic deficits are usually sudden and progressive. [merckmanuals.com]
- Nausea
Nausea, vomiting, delirium, and focal or generalized seizures are also common. Neurologic deficits are usually sudden and progressive. [merckmanuals.com]
Prominent nausea and vomiting in the setting of any focal neurologic deficit suggest the possibility of accompanying increased intracranial pressure, as often occurs with ICH. Of all the hypertensive ICH locations, it is the least common. [casemed.case.edu]
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]
Eyes
- Pupillary Abnormality
Initial emergency intracranial pressure management Emergency measures for ICP control are appropriate for stuporous or comatose patients, or those who present acutely with clinical signs of brain stem herniation (that is, pupillary abnormalities or motor [ccforum.biomedcentral.com]
Of note, 3 of the 7 patients with pupillary abnormalities made a good recovery, as did 4 of the 8 with clots >60 mL. [doi.org]
Neurologic
- Stroke
stroke. © 2015 World Stroke Organization. [ncbi.nlm.nih.gov]
Stroke. 2005;36:1881-1885 Published online before print August 4, 2005, doi: 10.1161/01.STR.0000177480.62341.6b ( Stroke. 2005;36:1881.) © 2005 American Heart Association, Inc. Edward Feldmann, MD ; Joseph P. Broderick, MD ; Walter N. [web.archive.org]
Smoking and the risk of hemorrhagic stroke in men. Stroke. 2003 ; 34 : 1151–1155. Link Google Scholar 16 Kurth T, Kase CS, Berger K, Gaziano JM, Cook NR, Buring JE. Smoking and the risk of hemorrhagic stroke in women. Stroke. 2003 ; 34 : 2792–2795. [doi.org]
- Headache
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]
Symptoms and Signs of Intracerebral Hemorrhage Symptoms of intracerebral hemorrhage typically begin with sudden headache, often during activity. However, headache may be mild or absent in older people. [msdmanuals.com]
- Confusion
An intracerebral hemorrhage happens when a blood vessel bursts in your brain The first symptom is usually a headache You may become confused or go into a coma Doctors will treat the problems that caused your bleeding, such as high blood pressure People [msdmanuals.com]
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]
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]
The term should not be confused with “intracranial hemorrhage,” which encompasses any type of bleeding within the skull, i.e., extradural, subdural, subarachnoid, and intracerebral. [amboss.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]
Renal and pulmonary complications failed to respond to therapy and the patient died 14 days after the onset of stupor. The cerebrospinal fluid was xanthochromic. [academic.oup.com]
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]
- Cognitive Impairment
The analysis method of EEG beta power abnormality holds a promise to assess the cognitive impairment post CH. [ncbi.nlm.nih.gov]
His mother was treated for progressive cognitive impairment, recurrent confusional state episodes and seizures. [omicsonline.org]
Workup
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]
Cerebrospinal Fluid
- 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]
Once an LP is performed, the CSF is evaluated for RBC count, and presence or absence of xanthochromia.[18] Treatment[edit] A selection of Mayfield and Drake aneurysm clips ready for implantation. [en.wikipedia.org]
Serum
- Hyperglycemia
Management of hyperglycemia Admission hyperglycemia is a potent predictor of 30-day mortality in both diabetic and non-diabetic patients with ICH [ 108 ]. The detrimental effect of hyperglycemia has been well studied in acute vascular syndromes. [ccforum.biomedcentral.com]
When a patient has constant hyperglycemia, the blood thickens and becomes viscous, if this happens blood pressure will elevate and thereby causing hypertension which is, of course, one of the most common causes of brain hemorrhage. [kwjoneslaw.com]
[…] a judicious approach to management of hyperglycemia was recommended. [doi.org]
Laboratory
- Leukocytosis
Both patients proved to have acute myeloid leukemia with marked leukocytosis, elevated blast counts, and thrombocytopenia. [neurology.org]
Thus, although leukocytosis or high blast count is associated with hemorrhagic risk, the proportion of blasts may not affect FICH. [nature.com]
On postoperative day 1, the patient developed septic shock with fever of 103.6 °F, fluid refractory hypotension, oliguria, increasing serum lactate and leukocytosis. [thoracic.org]
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]
Treatment Treatment for intracranial bleeding varies, depending on the underlying abnormality that caused the bleeding, the location of the bleeding and the size of the blood clot. [web.archive.org]
Prognosis
Alpha-frequency coma (AC) is a rare finding in comatose patients and is generally associated with a poor prognosis. [ncbi.nlm.nih.gov]
Patient prognosis was also compared with the general population using official Swedish mortality data. Clinical and radiological prognostic factors were evaluated. [jnnp.bmj.com]
The prognosis is generally poor after an intracerebral hemorrhage, although some patients can recover most function. Long-term mental and physical disability usually occurs. [uclahealth.org]
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]
Epidemiology
Most commonly affects the deep structures of the brain [3] Intraventricular extension occurs in approx. 30% of patients with ICH. [4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Neurology, Skåne University Hospital, Lund, Sweden 3 Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden 4 Department of Neurosurgery, Skåne University Hospital, Lund, Sweden 5 Department of Clinical Sciences Lund, Cancer Epidemiology [jnnp.bmj.com]
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]
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]
Prognosis Approximately 50% of all patients with ICH die within 30 days. [22] Intracerebral hemorrhage Summary Definition Epidemiology Etiology Pathophysiology Clinical features Diagnostics Initial evaluation Subsequent evaluation Treatment Medical therapy [amboss.com]
Jean Martin Charcot, 1825-1893 e Jean Martin Charcot e La Pitié-Salpêtrière – quatre siècles d’histoire e Historia de la medicina: Charles Jacques Bouchard e C.J.Bouchard e Pathology of Intracerebral Haemorrhage e Intracerebral Hemorrhage e Molecular Pathophysiology [patologia.medicina.ufrj.br]
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]
Prevention
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]
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]