Intracranial hemorrhage occurs in brain or meninges. Meningeal hemorrhage includes epidural, subdural, and subarachnoid types.
Intracerebral hemorrhage causes more death and disability than other strokes. Intracerebral hemorrhage causes edema to disrupt brain tissue and dysfunction.
Brain parenchyma displacement can increase intracranial pressure and herniation
It occurs in various brain areas and is classified into multiple types.
Types of Intracranial Hemorrhage are:
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Epidural Hemorrhage
Subdural Hemorrhage
Intracranial Hemorrhage is dangerous bleeding inside the skull. Ruptured blood vessel causes accumulation of blood in brain.
It increased intracranial pressure damages brain tissue. Blood products cause inflammation, injury to brain cells, and disrupt cerebral autoregulation.
Epidemiology
Intracerebral hemorrhage affects 12-15 per 100,000 individuals yearly. Asian countries have higher intracerebral hemorrhage incidence globally.
Over 20,000 Americans die annually from intracerebral hemorrhage, with a 30-day mortality rate of 44%.
Intracerebral hemorrhage occurs more in hypertensive African American populations.
Higher intracerebral hemorrhage rates observed in Asian populations may stem from environmental or genetic factors.
Intracerebral hemorrhage slightly favours males, while cerebral amyloid angiopathy may favour females.
Intracerebral hemorrhage incidence doubles every decade after age 55 until 80 years old.
Anatomy
Pathophysiology
Hypertensive damage causes most nontraumatic intracerebral hemorrhages.
Cranial trauma causes intracerebral hemorrhage frequently. Blunt head trauma patients on warfarin or clopidogrel face higher intracranial hemorrhage risk.
Rare delayed traumatic intracranial hemorrhage in warfarin patients. Intraventricular hemorrhage occurs in one-third of intracerebral hemorrhage cases due to extension.
Chronic hypertension leads to small vessel vasculopathy with lipohyalinosis and Charcot-Bouchard aneurysms in brain.
Etiology
The causes of intracranial hemorrhage are:
Vascular Malformations
Tumors
Illicit Drug Use
Vascular disease
Blood disorders
Substance use
Trauma
Infections
Age
Genetics
Prognostic Factors
Anticoagulation during hemorrhage increases hematoma size and outcomes.
Intraventricular extension worsens prognosis from hydrocephalus pressure.
Early hematoma growth significantly increases death and disability risk.
High blood glucose at presentation worsens outcomes and increases mortality.
Early surgical evacuation improves survival in large cerebellar hemorrhages.
Clinical History
Clinical History:
Collect details including the presenting symptoms, precipitating events, medical and family history to understand clinical history of patients.
Intracranial hemorrhage therapy emphasizes adjunctive measures for injury minimization and stabilization.
Clinical trials indicated that recombinant factor VIIa administered within 4 hours post-intracerebral hemorrhage limits hematoma growth and improves outcomes.
Early rFVIIa use in head injury patients without systemic coagulopathy may lower contusion enlargement and adverse outcomes.
Fosphenytoin or other anticonvulsants are recommended for seizures, while levetiracetam is effective for children’s prophylaxis.
Antihypertensive treatment study suggests more research on aggressive SBP reduction.
Maintain euvolemia with normotonic fluids for brain perfusion safety.
Use antihypertensives lower blood pressure to prevent hemorrhage.
Acetaminophen reduces fever and headache to prevent neurological injury.
Consider nonsurgical management for patients with minor deficits or small hemorrhage.
Consider surgery for cerebellar hemorrhage >3 cm and intracerebral hemorrhage with vascular lesions.
Surgical approaches include craniotomy, stereotactic aspiration, and endoscopic evacuation.
use-of-phases-in-managing-intracranial-hemorrhage
In the acute phase, the goal is to prevent hematoma expansion and manage life-threatening complications.
Pharmacologic therapy is effective in the treatment phase as it includes the use of antihypertensive agents, osmotic diuretics, antipyretics, analgesics, anticonvulsants, and antacids.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional procedures.
The regular follow-up visits with the neurologist are scheduled to check the improvement of patients along with treatment response.
Intracranial hemorrhage occurs in brain or meninges. Meningeal hemorrhage includes epidural, subdural, and subarachnoid types.
Intracerebral hemorrhage causes more death and disability than other strokes. Intracerebral hemorrhage causes edema to disrupt brain tissue and dysfunction.
Brain parenchyma displacement can increase intracranial pressure and herniation
It occurs in various brain areas and is classified into multiple types.
Types of Intracranial Hemorrhage are:
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Epidural Hemorrhage
Subdural Hemorrhage
Intracranial Hemorrhage is dangerous bleeding inside the skull. Ruptured blood vessel causes accumulation of blood in brain.
It increased intracranial pressure damages brain tissue. Blood products cause inflammation, injury to brain cells, and disrupt cerebral autoregulation.
Intracerebral hemorrhage affects 12-15 per 100,000 individuals yearly. Asian countries have higher intracerebral hemorrhage incidence globally.
Over 20,000 Americans die annually from intracerebral hemorrhage, with a 30-day mortality rate of 44%.
Intracerebral hemorrhage occurs more in hypertensive African American populations.
Higher intracerebral hemorrhage rates observed in Asian populations may stem from environmental or genetic factors.
Intracerebral hemorrhage slightly favours males, while cerebral amyloid angiopathy may favour females.
Intracerebral hemorrhage incidence doubles every decade after age 55 until 80 years old.
Hypertensive damage causes most nontraumatic intracerebral hemorrhages.
Cranial trauma causes intracerebral hemorrhage frequently. Blunt head trauma patients on warfarin or clopidogrel face higher intracranial hemorrhage risk.
Rare delayed traumatic intracranial hemorrhage in warfarin patients. Intraventricular hemorrhage occurs in one-third of intracerebral hemorrhage cases due to extension.
Chronic hypertension leads to small vessel vasculopathy with lipohyalinosis and Charcot-Bouchard aneurysms in brain.
The causes of intracranial hemorrhage are:
Vascular Malformations
Tumors
Illicit Drug Use
Vascular disease
Blood disorders
Substance use
Trauma
Infections
Age
Anticoagulation during hemorrhage increases hematoma size and outcomes.
Intraventricular extension worsens prognosis from hydrocephalus pressure.
Early hematoma growth significantly increases death and disability risk.
High blood glucose at presentation worsens outcomes and increases mortality.
Early surgical evacuation improves survival in large cerebellar hemorrhages.
Clinical History:
Collect details including the presenting symptoms, precipitating events, medical and family history to understand clinical history of patients.
Intracranial hemorrhage therapy emphasizes adjunctive measures for injury minimization and stabilization.
Clinical trials indicated that recombinant factor VIIa administered within 4 hours post-intracerebral hemorrhage limits hematoma growth and improves outcomes.
Early rFVIIa use in head injury patients without systemic coagulopathy may lower contusion enlargement and adverse outcomes.
Fosphenytoin or other anticonvulsants are recommended for seizures, while levetiracetam is effective for children’s prophylaxis.
Antihypertensive treatment study suggests more research on aggressive SBP reduction.
Maintain euvolemia with normotonic fluids for brain perfusion safety.
Use antihypertensives lower blood pressure to prevent hemorrhage.
Acetaminophen reduces fever and headache to prevent neurological injury.
Neurology
Access to emergency equipment in the form of suction, oxygen, and airway equipment at bedside.
Start enteral feedings promptly and consider nasogastric or percutaneous device placement.
Patient should maintain bedrest during the first 24 hours. Patient should avoid strenuous exertion.
Proper awareness about intracranial hemorrhage should be provided and its related causes with management strategies.
Appointments with neurologist and preventing recurrence of disorder is an ongoing life-long effort.
Neurology
Nicardipine:
It is a calcium channel blocker that acts as a potent rapid onset of action and ease of titration.
Neurology
Mannitol:
It reduces cerebral edema with help of osmotic forces and decreases blood viscosity.
Neurology
Acetaminophen:
It works peripherally to block pain impulse generation in CNS.
Neurology
Fosphenytoin:
It stabilizes neuronal membranes and decreases seizure activity.
Neurology
Famotidine:
It inhibits histamine at H2 receptor of gastric parietal cells to reduce gastric acid secretion.
Neurology
Consider nonsurgical management for patients with minor deficits or small hemorrhage.
Consider surgery for cerebellar hemorrhage >3 cm and intracerebral hemorrhage with vascular lesions.
Surgical approaches include craniotomy, stereotactic aspiration, and endoscopic evacuation.
Neurology
In the acute phase, the goal is to prevent hematoma expansion and manage life-threatening complications.
Pharmacologic therapy is effective in the treatment phase as it includes the use of antihypertensive agents, osmotic diuretics, antipyretics, analgesics, anticonvulsants, and antacids.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional procedures.
The regular follow-up visits with the neurologist are scheduled to check the improvement of patients along with treatment response.
Intracranial hemorrhage occurs in brain or meninges. Meningeal hemorrhage includes epidural, subdural, and subarachnoid types.
Intracerebral hemorrhage causes more death and disability than other strokes. Intracerebral hemorrhage causes edema to disrupt brain tissue and dysfunction.
Brain parenchyma displacement can increase intracranial pressure and herniation
It occurs in various brain areas and is classified into multiple types.
Types of Intracranial Hemorrhage are:
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Epidural Hemorrhage
Subdural Hemorrhage
Intracranial Hemorrhage is dangerous bleeding inside the skull. Ruptured blood vessel causes accumulation of blood in brain.
It increased intracranial pressure damages brain tissue. Blood products cause inflammation, injury to brain cells, and disrupt cerebral autoregulation.
Intracerebral hemorrhage affects 12-15 per 100,000 individuals yearly. Asian countries have higher intracerebral hemorrhage incidence globally.
Over 20,000 Americans die annually from intracerebral hemorrhage, with a 30-day mortality rate of 44%.
Intracerebral hemorrhage occurs more in hypertensive African American populations.
Higher intracerebral hemorrhage rates observed in Asian populations may stem from environmental or genetic factors.
Intracerebral hemorrhage slightly favours males, while cerebral amyloid angiopathy may favour females.
Intracerebral hemorrhage incidence doubles every decade after age 55 until 80 years old.
Hypertensive damage causes most nontraumatic intracerebral hemorrhages.
Cranial trauma causes intracerebral hemorrhage frequently. Blunt head trauma patients on warfarin or clopidogrel face higher intracranial hemorrhage risk.
Rare delayed traumatic intracranial hemorrhage in warfarin patients. Intraventricular hemorrhage occurs in one-third of intracerebral hemorrhage cases due to extension.
Chronic hypertension leads to small vessel vasculopathy with lipohyalinosis and Charcot-Bouchard aneurysms in brain.
The causes of intracranial hemorrhage are:
Vascular Malformations
Tumors
Illicit Drug Use
Vascular disease
Blood disorders
Substance use
Trauma
Infections
Age
Anticoagulation during hemorrhage increases hematoma size and outcomes.
Intraventricular extension worsens prognosis from hydrocephalus pressure.
Early hematoma growth significantly increases death and disability risk.
High blood glucose at presentation worsens outcomes and increases mortality.
Early surgical evacuation improves survival in large cerebellar hemorrhages.
Clinical History:
Collect details including the presenting symptoms, precipitating events, medical and family history to understand clinical history of patients.
Intracranial hemorrhage therapy emphasizes adjunctive measures for injury minimization and stabilization.
Clinical trials indicated that recombinant factor VIIa administered within 4 hours post-intracerebral hemorrhage limits hematoma growth and improves outcomes.
Early rFVIIa use in head injury patients without systemic coagulopathy may lower contusion enlargement and adverse outcomes.
Fosphenytoin or other anticonvulsants are recommended for seizures, while levetiracetam is effective for children’s prophylaxis.
Antihypertensive treatment study suggests more research on aggressive SBP reduction.
Maintain euvolemia with normotonic fluids for brain perfusion safety.
Use antihypertensives lower blood pressure to prevent hemorrhage.
Acetaminophen reduces fever and headache to prevent neurological injury.
Neurology
Access to emergency equipment in the form of suction, oxygen, and airway equipment at bedside.
Start enteral feedings promptly and consider nasogastric or percutaneous device placement.
Patient should maintain bedrest during the first 24 hours. Patient should avoid strenuous exertion.
Proper awareness about intracranial hemorrhage should be provided and its related causes with management strategies.
Appointments with neurologist and preventing recurrence of disorder is an ongoing life-long effort.
Neurology
Nicardipine:
It is a calcium channel blocker that acts as a potent rapid onset of action and ease of titration.
Neurology
Mannitol:
It reduces cerebral edema with help of osmotic forces and decreases blood viscosity.
Neurology
Acetaminophen:
It works peripherally to block pain impulse generation in CNS.
Neurology
Fosphenytoin:
It stabilizes neuronal membranes and decreases seizure activity.
Neurology
Famotidine:
It inhibits histamine at H2 receptor of gastric parietal cells to reduce gastric acid secretion.
Neurology
Consider nonsurgical management for patients with minor deficits or small hemorrhage.
Consider surgery for cerebellar hemorrhage >3 cm and intracerebral hemorrhage with vascular lesions.
Surgical approaches include craniotomy, stereotactic aspiration, and endoscopic evacuation.
Neurology
In the acute phase, the goal is to prevent hematoma expansion and manage life-threatening complications.
Pharmacologic therapy is effective in the treatment phase as it includes the use of antihypertensive agents, osmotic diuretics, antipyretics, analgesics, anticonvulsants, and antacids.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional procedures.
The regular follow-up visits with the neurologist are scheduled to check the improvement of patients along with treatment response.
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