7/27/2019 CEREBRAL HEMORRHAGE.docx

1/2

CEREBRAL HEMORRHAGE

A cerebral hemorrhage (also spelled haemorrhage) is a subtype ofintracranial hemorrhage that

occurs within thebrain tissue itself. It is alternatively called intracerebral hemorrhage (ICH). It

can be caused bybrain trauma,or it can occur spontaneously inhemorrhagic stroke.Non-

traumatic intracerebral hemorrhage is a spontaneous bleeding into the brain tissue.

[1]

A cerebral hemorrhage is an intra-axial hemorrhage; that is, it occurs within the brain tissue

rather than outside of it. The other category of intracranial hemorrhage is extra-axial

hemorrhage, such asepidural,subdural,andsubarachnoid hematomas,which all occur within the

skull but outside of the brain tissue. There are two main kinds of intra-axial

hemorrhages:intraparenchymal hemorrhage andintraventricular hemorrhages.As with other

types of hemorrhages within the skull, intraparenchymal bleeds are a seriousmedical

emergencybecause they can increaseintracranial pressure,which if left untreated can lead

tocoma and death. Themortality rate for intraparenchymal bleeds is over 40%.

Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled

by the area of the brain that is damaged by the bleed.[3]

Other symptoms include those that

indicate a rise inintracranial pressure due to a large mass putting pressure on the

brain.[3]

Intracerebral hemorrhages are often misdiagnosed assubarachnoid hemorrhages due to

the similarity in symptoms and signs. A severe headache followed by vomiting is one of the

more common symptoms of intracerebral hemorrhage. Some patients may also go into a coma

before the bleed is noticed.

Intracerebral bleeds are the second most common cause ofstroke,accounting for 3060% of

hospital admissions for stroke.High blood pressure raises the risks of spontaneous intracerebral

hemorrhage by two to six times.[1]More common in adults than in children, intraparenchymal

bleeds are usually due topenetrating head trauma,but can also be due to depressedskull

fractures.Acceleration-deceleration trauma,[4][5][6]

rupture of ananeurysmorarteriovenous

malformation (AVM), and bleeding within atumor are additional causes. Amyloid angiopathy is

a not uncommon cause of intracerebral hemorrhage in patients over the age of 55. A very small

proportion is due tocerebral venous sinus thrombosis.Infection with the kserotype

ofStreptococcus mutansmay also be a risk factor, due to its prevalence in stroke patients and

production ofcollagen-binding protein.[7]

Risk factors for ICH include:[8]

Hypertension ( also known as High Blood Pressure) Diabetes Mellitus Menopause Currentcigarette smoking Alcoholic drinks (2/day)Tramautic intracerebral Hematomas are divided into acute and delayed. Acute intracerebral

Hematomas occur at the time of the injury while delayed intracerebral Hematomas have been

http://en.wikipedia.org/wiki/Intracranial_hemorrhagehttp://en.wikipedia.org/wiki/Brain_tissuehttp://en.wikipedia.org/wiki/Acquired_brain_injuryhttp://en.wikipedia.org/wiki/Hemorrhagic_strokehttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Epidural_haematomahttp://en.wikipedia.org/wiki/Subdural_hematomahttp://en.wikipedia.org/wiki/Subarachnoid_hematomahttp://en.wikipedia.org/wiki/Intraparenchymal_hemorrhagehttp://en.wikipedia.org/wiki/Intraventricular_hemorrhageshttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Mortality_ratehttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Vinas_and_Pilistis-3http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Vinas_and_Pilistis-3http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Vinas_and_Pilistis-3http://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Vinas_and_Pilistis-3http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Vinas_and_Pilistis-3http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Vinas_and_Pilistis-3http://en.wikipedia.org/wiki/Subarachnoid_hemorrhagehttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Penetrating_head_traumahttp://en.wikipedia.org/wiki/Skull_fracturehttp://en.wikipedia.org/wiki/Skull_fracturehttp://en.wikipedia.org/w/index.php?title=Acceleration-deceleration_trauma&action=edit&redlink=1http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Shepherd-6http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Shepherd-6http://en.wikipedia.org/wiki/Aneurysmhttp://en.wikipedia.org/wiki/Arteriovenous_malformationhttp://en.wikipedia.org/wiki/Arteriovenous_malformationhttp://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosishttp://en.wikipedia.org/wiki/Streptococcus_mutanshttp://en.wikipedia.org/wiki/Streptococcus_mutanshttp://en.wikipedia.org/wiki/Streptococcus_mutanshttp://en.wikipedia.org/w/index.php?title=Collagen-binding_protein&action=edit&redlink=1http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-7http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-7http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-7http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-8http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-8http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-8http://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Diabetes_Mellitushttp://en.wikipedia.org/wiki/Menopausehttp://en.wikipedia.org/wiki/Cigarette_smokinghttp://en.wikipedia.org/wiki/Cigarette_smokinghttp://en.wikipedia.org/wiki/Menopausehttp://en.wikipedia.org/wiki/Diabetes_Mellitushttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-8http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-7http://en.wikipedia.org/w/index.php?title=Collagen-binding_protein&action=edit&redlink=1http://en.wikipedia.org/wiki/Streptococcus_mutanshttp://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosishttp://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Arteriovenous_malformationhttp://en.wikipedia.org/wiki/Arteriovenous_malformationhttp://en.wikipedia.org/wiki/Aneurysmhttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Shepherd-6http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/w/index.php?title=Acceleration-deceleration_trauma&action=edit&redlink=1http://en.wikipedia.org/wiki/Skull_fracturehttp://en.wikipedia.org/wiki/Skull_fracturehttp://en.wikipedia.org/wiki/Penetrating_head_traumahttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Subarachnoid_hemorrhagehttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Vinas_and_Pilistis-3http://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Vinas_and_Pilistis-3http://en.wikipedia.org/wiki/Mortality_ratehttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Intraventricular_hemorrhageshttp://en.wikipedia.org/wiki/Intraparenchymal_hemorrhagehttp://en.wikipedia.org/wiki/Subarachnoid_hematomahttp://en.wikipedia.org/wiki/Subdural_hematomahttp://en.wikipedia.org/wiki/Epidural_haematomahttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Hemorrhagic_strokehttp://en.wikipedia.org/wiki/Acquired_brain_injuryhttp://en.wikipedia.org/wiki/Brain_tissuehttp://en.wikipedia.org/wiki/Intracranial_hemorrhage

7/27/2019 CEREBRAL HEMORRHAGE.docx

2/2

reported from as early as 6 hours post injury to as long as several weeks. It is important to keep

in mind that intracerebral Hematomas can be delayed because if symptoms begin to appear

several weeks after the injury, concussion is no longer considered and the symptoms may not be

connected to the injury.

Intraparenchymal hemorrhage can be recognized onCT scansbecause blood appears brighter

than other tissue and is separated from the inner table of the skull by brain tissue. The tissue

surrounding a bleed is often less dense than the rest of the brain due toedema,and therefore

shows up darker on the CT scan. Frequently, a CT angiogram will be performed in order to

exclude a secondary cause of hemorrhage[9]

or to detect a "spot sign".

Treatment depends substantially of the type of ICH. RapidCT scan and other diagnostic

measures are used to determine proper treatment, which may include both medication and

surgery.

The risk of death from an intraparenchymal bleed in traumatic brain injury is especially high

when the injury occurs in thebrain stem.[2]

Intraparenchymal bleeds within themedulla

oblongata are almost always fatal, because they cause damage to cranial nerve X, thevagus

nerve,which plays an important role inblood circulation and breathing.[4]

This kind of

hemorrhage can also occur in thecortex or subcortical areas, usually in thefrontal ortemporal

lobes when due to head injury, and sometimes in thecerebellum.[4][15]

For spontaneous ICH seen on CT scan, the death rate (mortality)is 3450% by 30 days after the

insult,[1]

and half of the deaths occur in the first 2 days.[16]

The inflammatory response triggered by stroke has been viewed as harmful in the early stage,

focusing on blood-borne leukocytes, neutrophils and macrophages, and resident microglia andastrocytes.

[17]New area of interest are the Mast Cells.

It accounts for 20% of all cases ofcerebrovascular disease in the US, behindcerebral

thrombosis (40%) andcerebral embolism(30%).[19]

It is two or more times more prevalent inblackpatients than it is inwhitepatients

http://en.wikipedia.org/wiki/Intraparenchymal_hemorrhagehttp://en.wikipedia.org/wiki/CT_scanhttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-9http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-9http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-9http://en.wikipedia.org/wiki/CT_scanhttp://en.wikipedia.org/wiki/Brain_stemhttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Sanders_and_McKenna-2http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Sanders_and_McKenna-2http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Sanders_and_McKenna-2http://en.wikipedia.org/wiki/Medulla_oblongatahttp://en.wikipedia.org/wiki/Medulla_oblongatahttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Blood_circulationhttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebral_cortexhttp://en.wikipedia.org/wiki/Frontal_lobehttp://en.wikipedia.org/wiki/Temporal_lobehttp://en.wikipedia.org/wiki/Temporal_lobehttp://en.wikipedia.org/wiki/Cerebellumhttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Mortality_ratehttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-16http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-16http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-16http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-17http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-17http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-17http://en.wikipedia.org/wiki/Cerebrovascular_diseasehttp://en.wikipedia.org/wiki/Cerebral_thrombosishttp://en.wikipedia.org/wiki/Cerebral_thrombosishttp://en.wikipedia.org/wiki/Cerebral_embolismhttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-19http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-19http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-19http://en.wikipedia.org/wiki/Black_peoplehttp://en.wikipedia.org/wiki/White_peoplehttp://en.wikipedia.org/wiki/White_peoplehttp://en.wikipedia.org/wiki/Black_peoplehttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-19http://en.wikipedia.org/wiki/Cerebral_embolismhttp://en.wikipedia.org/wiki/Cerebral_thrombosishttp://en.wikipedia.org/wiki/Cerebral_thrombosishttp://en.wikipedia.org/wiki/Cerebrovascular_diseasehttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-17http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-16http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Yadav07-1http://en.wikipedia.org/wiki/Mortality_ratehttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Cerebellumhttp://en.wikipedia.org/wiki/Temporal_lobehttp://en.wikipedia.org/wiki/Temporal_lobehttp://en.wikipedia.org/wiki/Frontal_lobehttp://en.wikipedia.org/wiki/Cerebral_cortexhttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-McCaffrey-4http://en.wikipedia.org/wiki/Blood_circulationhttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Medulla_oblongatahttp://en.wikipedia.org/wiki/Medulla_oblongatahttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-Sanders_and_McKenna-2http://en.wikipedia.org/wiki/Brain_stemhttp://en.wikipedia.org/wiki/CT_scanhttp://en.wikipedia.org/wiki/Cerebral_hemorrhage#cite_note-9http://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/CT_scanhttp://en.wikipedia.org/wiki/Intraparenchymal_hemorrhage