A cerebral hemorrhage is a bleed into the substance of the cerebrum . All cerebral hematomas, whatever the cause, have a similar resolution pattern on CT. The rate of resolution depends on the size of the hematoma, usually within one to six weeks, and they resorb from the outside toward the center. Accumulation of blood occurs over minutes or hours and the neurologic symptoms usually increase gradually over minutes or a few hours.Lobar intracerebral hemorrhage is bleeding in the largest part of the brain called the cerebrum. ICH has a mortality rate of 44 percent after 30 days, higher than ischemic stroke or even the very deadly subarachnoid hemorrhage (Liebeskind, 2004). The end result of a hematoma is decreased parenchymal density, focal atrophy and local ventricular dilatation.
With hemorrhage into the cerebral hemisphere, consciousness is initially lost or impaired in about one-half of patients. Vomiting occurs very frequently at the onset of bleeding, and headache is sometimes present. Focal symptoms and signs then develop, depending on the site of the hemorrhage. With hypertensive hemorrhage, there is generally a rapidly evolving neurologic deficit with hemiplegia or hemiparesis. A hemisensory disturbance is also present with more deeply placed lesions. With lesions of the putamen, loss of conjugate lateral gaze may be conspicuous. With thalamic hemorrhage, there may be a loss of upward gaze, downward or skew deviation of the eyes, lateral gaze palsies, and pupillary inequalities.
Cerebellar hemorrhage may present with sudden onset of nausea and vomiting, disequilibrium, headache, and loss of consciousness that may terminate fatally within 48 hours. Less commonly, the onset is gradual and the course episodic or slowly progressive—clinical features suggesting an expanding cerebellar lesion. In yet other cases, however, the onset and course are intermediate, and examination shows lateral conjugate gaze palsies to the side of the lesion; small reactive pupils; contralateral hemiplegia; peripheral facial weakness; ataxia of gait, limbs, or trunk; periodic respiration; or some combination of these findings.
The rate of resolution depends on the size of the hematoma, usually within one to six weeks, and they resorb from the outside toward the center. Diabetes and psychiatric morbidity were associated with nonlobar PICH. Smoking doubled the risk for lobar PICH, but was unrelated to nonlobar PICH. The bleeding is directly into the brain, forming a localized hematoma that spreads along white matter pathways The limited number of randomized controlled studies of treatment of ICH severely limit strong, positive recommendations for any intervention. Thus, these guidelines should be viewed as a basis for the development of future clinical trials, which are desperately needed.
Causes of Intracerebral Hemorrhage
Here are the list of the possible causes of Intracerebral Hemorrhage :
Symptoms of Intracerebral Hemorrhage
Some sign and aymptoms related to Intracerebral Hemorrhage:
Treatment of Intracerebral Hemorrhage
Neurologic management is generally conservative and supportive, regardless of whether the patient has a profound deficit with associated brain stem compression, in which case the prognosis is grim, or a more localized deficit not causing increased intracranial pressure or brain stem involvement. Decompression is helpful, however, when a superficial hematoma in cerebral white matter is exerting a mass effect and causing incipient herniation. In patients with cerebellar hemorrhage, prompt surgical evacuation of the hematoma is appropriate, because spontaneous unpredictable deterioration may otherwise lead to a fatal outcome and because operative treatment may lead to complete resolution of the clinical deficit. The treatment of underlying structural lesions or bleeding disorders depends upon their nature.
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