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8 Cards in this Set

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Definition of Intracerebral hemorrhage (ICH)?
hemorrhage w/in brain parenchyma (=10% of strokes)
can dissect into ventricular system (IVH) or cortical surface (SAH)
Etiology of ICH?
HT
hemorrhagic transformation (reperfusion post stroke, surgery, strenous exercise, etc)
vascular anomalies (aneursym, AVM, venous sinus thrombosis, arteriopathies (vasculitis))
tumors
drugs (amphetamines, cocaine, EtOH)
coagulopathy (warfarin, rPA) CNS infections (granulomas, herpes encephalitis)
post trauma (immed/delayed, frontal and temporal most commonly injured in coup/contrecoup)
eclampsia
postop (carotid endarterectomy, craniotomy), idiopathic
Risk factors for ICH?
age (>55)
male
HT
Black/Asion> white
prev CVA (3 X risk)
both acute and chronic EtOh use
cocaine
amphetamine
liver disease,
SSx of ICH?
TIA-like Sx often precede ICH, can localize site of impending hemorrhage, location: basal ganglia/int capsule (50%)
gradual onset of Sx (min to hrs, usually w/ activity)
H/A
vomiting
decreased LOC common,
Ix of ICH?
high density blood on CT W/O contrast

angiogram to r/o vascular lesion UNLESS >45 yrs, Known HT, AND putamen/thalamic/post fossa ICH (yield approx 0%)
Treatment of ICH?
Medical:
MEDS:
phenytoin for seizure prophyaxis
FLUIDS:
Follow lytes (SIADH common) control raised ICP
decr BP to premorbid or by 20%
check for coagulopathy (follow PTT, INR), PROCEDURE:
angiogram to r/o vascular lesion UNLESS >45 yrs, Known HT, AND putamen/thalamic/post fossa ICH (yield approx 0%)

Surgical:
Craniotomy w/ evacuation of clot, resection of source of ICH (eg tumor, AVM, ventriculostomy to treat hydrocephalus)
Surgery indications and CI for treating ICH?
Indications:
Sx appears to be related to raised ICP/mass effect
rapid deterioriation (esp if brainstem compression signs) favorable location (eg cerebellar, non-dom hemisphere)
< 50 yrs age
if tumor, AVM, aneurysm, cavernoma suspected (resection fo clip to decr risk of bleed)

Contraindications:
small bleed: minimal Sx GCS > 10 (not necessary)
poor prognosis: massive hemorrhage (esp dominant lobe), low GCS/coma, lost brainstem function
medical reasons (v. elderly, severe coagulatophy, difficult location (basal ganglia, thalamus)
Prognosis for ICH?
30 day Mort rate is 44%, mostly due to cerebral herniation
rebleed is 2-6% higher, if HT poorly controlled