Intraparenchymal hemorrhage
This article needs more primary sources. (June 2018) |
Intraparenchymal hemorrhage | |
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Other names | Intraparenchymal bleed |
Multiple intraparenchymal hemorrhage |
Intraparenchymal hemorrhage (IPH) is one form of
Intraparenchymal hemorrhage accounts for approximately 8-13% of all
Signs and symptoms
Clinical manifestations of intraparenchymal hemorrhage are determined by the size and location of hemorrhage, but may include the following:[citation needed]
- Hypertension, cardiac arrhythmias
- Nuchal rigidity
- Subhyaloid retinal hemorrhages
- Altered level of consciousness
- Anisocoria, nystagmus
- Focal neurological deficits
- Putamen - Contralateral hemiparesis, contralateral sensory loss, contralateral conjugate gaze paresis, homonymous hemianopsia, aphasia, neglect, or apraxia
- Thalamus - Contralateral sensory loss, contralateral hemiparesis, gaze paresis, homonymous hemianopia, miosis, aphasia, or confusion
- Lobar - Contralateral hemiparesis or sensory loss, contralateral conjugate gaze paresis, homonymous hemianopia, abulia, aphasia, neglect, or apraxia
- Caudate nucleus - Contralateral hemiparesis, contralateral conjugate gaze paresis, or confusion
- autonomic instability
- Cerebellum - Ataxia, usually beginning in the trunk, ipsilateral facial weakness, ipsilateral sensory loss, gaze paresis, skew deviation, miosis, or decreased level of consciousness
Causes
- Hypertension
- Arteriovenous malformation
- Aneurysm rupture
- Cerebral amyloid angiopathy
- Intracranial neoplasm
- Coagulopathy
- Hemorrhagic transformation of an ischemic stroke
- Cerebral venous thrombosis
- Sympathomimetic drug abuse
- Moyamoya disease
- Sickle cell disease
- Eclampsia or postpartum vasculopathy
- Infection
- Vasculitis
- Neonatal intraventricular hemorrhage
- Trauma
In younger patients, vascular malformations, specifically AVMs and
In the elderly population, amyloid angiopathy is associated with
Hemorrhagic neoplasms are more complex, heterogeneous bleeds often with associated edema. These hemorrhages are related to tumor necrosis,
Other causes of intraparenchymal hemorrhage include hemorrhagic transformation of infarction which is usually in a classic vascular distribution and is seen in approximately 24 to 48 hours following the ischemic event. This hemorrhage rarely extends into the ventricular system.
Pathophysiology
Nontraumatic intraparenchymal hemorrhage most commonly results from hypertensive damage to blood vessel walls e.g.: - hypertension - eclampsia -
Diagnosis
Computed tomography (CT scan): A CT scan may be normal if it is done soon after the onset of symptoms. A CT scan is the best test to look for bleeding in or around your brain. In some hospitals, a perfusion CT scan may be done to see where the blood is flowing and not flowing in your brain.
Magnetic resonance imaging (MRI scan): A special MRI technique (diffusion MRI) may show evidence of an ischemic stroke within minutes of symptom onset. In some hospitals, a perfusion MRI scan may be done to see where the blood is flowing and not flowing in your brain.
Angiogram: a test that looks at the blood vessels that feed the brain. An
Carotid duplex: A
Transcranial Doppler (TCD): Transcranial Doppler is an ultrasound study that assesses whether or not you have atherosclerosis (narrowing) of the blood vessels inside of your brain. It can also be used to see if you have emboli (blood clots) in your blood vessels.
Treatment
Intracerebral hemorrhages is a severe condition requiring prompt medical attention. Treatment goals include lifesaving interventions, supportive measures, and control of symptoms. Treatment depends on the location, extent, and cause of the bleeding. Often, treatment can reverse the damage that has been done.
A craniotomy is sometimes done to remove blood, abnormal blood vessels, or a tumor. Medications may be used to reduce swelling, prevent seizures, lower blood pressure, and control pain.
References
- S2CID 91189795. Retrieved 28 February 2021.