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Published byArthur Collins Modified over 8 years ago
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INTRACEREBRAL HAEMORRHAGE SUPRAENTORIAL(LOBAR,BASAL GANGLIA INFRATENTORIAL(CEREBELLUM,PONS,BRAINSTEM) INCIDENCE 15 TO35 PER 100,000 SURVIVAL 38% IN Good Working Conditions
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RISK FACTORS AGE SEX BLOOD PRESSURE ALCOHOL CONSUMPTION CHOLESTEROL LEVELS----LOW LEVELS(Arachidonic Acid)
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AETIOLOGY PRIMARY------Chronic hypertension:degeneration in perforators and microaneurysms formation Amyloid angiopathy:medium and small sized vessels over the surface of brain SECONDARY------Aneurysms, AVM, Tumors, Coagulopthy
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LOCATION LOBAR-20% BASAL GANGLION REGION-50% CEREBELLUM-10% PONS-10 TO 15% THALAMUS-15% OTHER BRAIN STEM SITES-1 TO 6%
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PATHOPHYSIOLOGY HEMATOMA AND SURROUNDING EDEMA DUE TO EXTRAVASATED BLOOD PROTEINS OSMOTIC PRESSURE IMBIBING WATER VASOGENIC EDEMA-DUE TO THROMBIN FORMATION AFTER 24 HOURS THAT DISRUPTS THE BLOOD BRAIN BARRIER AFTER 5 DAYS LYSIS OF HAEMOGLOBIN PRODUCES FREE RADICALS WHICH ACCOUNTS FOR THE LATEONSET OF EDEMA
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CLINICAL FEATURES SEVERE HEAD ACHE FOCAL SIGNS FITS DETERIORATION OF CONSCIOUS LEVEL DEEP COMA DUE TO HERNIATION AND RAISED ICP
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RADIOLOGICAL DIAGNOSIS CT-SCAN—TO KNOW THE DIMENSIONS AND THE VOLUME OF HEMATOMA CT ANGIOGRAPHY---TO LOCATE THE ANEURYSMS AND AVM DIGITAL SUBTRACTION ANGIOGRAPHY---SAME AS ABOVE MRA— MRI---TO KNOW THW DIFFERENT STAGES OF HEMATOMA
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MEDICAL TREATMENT CONTROL OF BLOOD PRESSURE CONTROL OF ICP BY OSMOTIC DIURETICS LIKE 20% MANNITOL AND HYPERTONIC SALINE (23.4%)30ml CORRECTION OF COAGULOPTHY BY FFP,VIT K, PROTHROMBIN COMPLEX CONCENTRATE ICU
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SURGICAL THERAPEUTICS CRANIOTOMY---SUPRATENTORIAL HEMATOMAS THAT ARE MORE THAN 30ml,CERBELLAR THAT ARE MORE THAT 3CM IN SIZE STEROTACTIC ASPIRATION ENDOSCOPIC
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