 Name: Amira Esam
 Name: Reem Mohamed
 Name: Hadeer Khalfalla
 Name: Yossra Helal
 Name: Rawda Abdelmenam
 Name: Tasneem Tarek
 Name: Yara Sabry
 Name: Reham Abd Elhameed
 Name: Alaa Maged
 Name : Alaa Mohamed
 Name: Walaa Shaban
Designed by
Under supervision
of
2nd year: group(26) -2017- Anatomy department
1) Anatomy of Cerebral Vessels
2) Cerebral Hemorrhage
3) Causes
4) Epidemiology
5) Stages
6) Clinical Picture
7) Investigation
8) Treatment
9) Follow UP
10)Patient Education
2nd year: group(26) -2017- Anatomy department
IS AN ANASTOMOTIC SYSTEM OF ARTERIES THAT
SITS AT THE BASE OF THE BRAIN.
• ANTERIOR CEREBRAL ARTERY
• ICA
• POSTERIOR COMMUNTICATING ARTERY
• POSTIRIOR CEREBRAL ARTERY
2nd year: group(26) -2017- Anatomy department
SUPERFICIAL SYSTEM OF VEINS :-
SUPERIOR CEREBRAL VEIN
MIDDLE CEREBRAL VEIN ( SUPERFICIAL &
DEEP )
INFERIOR CEREBRAL VEIN
DEEP SYSTEM OF VEINS :-
THALAMOSTRIATE VEINS
CHOROID VEINS
INTERNAL CEREBRAL VEINS
GREAT CEREBRAL VEIN
Cerebral
Veins
2nd year: group(26) -2017- Anatomy department
2nd year: group(26) -2017- Anatomy department
 IS THE PATHOLOGICAL ACCUMULATION OF BLOOD WITHIN THE CRANIAL VAULT MAY
OCCUR WITHIN BRAIN PARENCHYMA OR THE SURROUNDING MENINGEAL SPACES.
 IT ACCOUNTS FOR 8-13% OF ALL STROKES .
 ALSO IS MORE LIKELY TO RESULT IN DEATH OR MAJOR DISABILITY
 INTRACEREBRAL HEMORRHAGE AND ACCOMPANYING EDEMA MAY DISRUPT OR
COMPRESS ADJACENT BRAIN TISSUE, LEADING TO NEUROLOGICAL DYSFUNCTION.
 DISPLACEMENT OF BRAIN PARENCHYMA MAY CAUSE ↑(ICP) AND FATAL HERNIATION
SYNDROMES.
2nd year: group(26) -2017- Anatomy department
CAUSES
Hypertensio
n
Aneurysm A-V
malformation
Tumor Cranial
Trauma
Anti Coagulant
Drugs
• Age of 55 and
doubles with
each deacade
till 80
Age
• Africans due to
hypertension
Race
• Slight male
predominance
Sex
Epidemiology
2nd year: group(26) -2017- Anatomy department
Phase TIME HB ,
Location
o Hyper acute < 24 h Oxyhemoglobin,
intracellular
oAcute 1-3 d Deoxyhemoglobin,
intracellular
o Early subacute >3 d Methemoglobin,
intracellular
o Late subacute >7 d Methemoglobin,
extracellular
o Chronic >14 d Ferritin and hemosiderin,
extracellular
Stages
2nd year: group(26) -2017- Anatomy department
Altered
conscio
us level
(50%)
Headach
e
( 40%)
Nausea
and
vomiting
( 40%)
Seizures
( 6-7%)
focal
numbness,
tingling, or
weakness
Onset of symptoms of intracerebral hemorrhage is usually during daytime
activity, with progressive (ie, minutes to hours) development of the following:
NEUROLOGICAL SYMPTOMS ACCORDING
TO SITE:
Thalamus
sensory loss
Brain stem
facial weakness
Cerebellum
Ataxia
• ECG DIAGNOSIS: DEEP T WAVE INVERSIONS ASSOCIATED WITH
INTRACRANIAL HEMORRHAGE
• SPONTANEOUS CEREBRAL HEMORRHAGE IN A PATIENT WITH ESSENTIAL
HYPERTENSION.
• BOTH CT ANGIOGRAPHY & MR ANGIOGRAPHY HAVE PROVIDE TO BE EFFECTIVE IN THE
DIAGNOSIS OF INTRACRANIAL HEMORRHAGE SO CT IS PERFORMED TO EXCLUDE A 2RY
CAUSE OF HEMORRHAGE OR TO DETECT A SPOT SIGN.
2ND YEAR: GROUP(26) -2017- ANATOMY DEPARTMENT
INTRAPARENCHYMAL HEMORRHAGE CAN BE
RECOGNIZED ON CT SCANS AS THE BLOOD APPEARS
BRIGHTER THAN OTHER TISSUES ALSO THE TISSUE THAT
SURROUND THE BLEED KINDA DENSE THAN THE REST OF
THE BRAIN BECAUSE OF EDEMA
• MAGNETIC RESONANCE IMAGING
(MRI)
• LUMBAR PUNCTURE (CSF
EXAMINATION)
• GRADIENT ECHO (GRE)
2ND YEAR: GROUP(26) -2017- ANATOMY
SUBACUTE SUBDURAL HEMATOMA IN A RIGHT FRONTOPARIETAL CONCAVITY.
CT SCAN (CT) SHOWS AN ISOATTENUATING-TO-HYPOATTENUATING
SUBDURAL HEMATOMA. BOTH T1-WEIGHTED (T1W) AND T2-WEIGHTED (T2W)
MR IMAGES SHOW HIGH SIGNAL INTENSITY SUGGESTIVE OF A LATE
SUBACUTE HEMORRHAGE.
2nd year: group(26) -2017- Anatomy department
THIS MRI REVEALS HEMORRHAGIC
TRANSFORMATION OF AN ISCHEMIC
INFARCT.
2nd year: group(26) -2017- Anatomy department
complications
Seizures
Hydrocephalus Brain
Herniation
Pulmonary
Embolism
Venous
Thrombosis
 PHARMACOLOGICAL :-
• ANTIHYPERTENSIVE AGENTS
• OSMOTIC DIURETICS
• ANTIPYRETICS, ANALGESICS
• ANTICONVULSANTS
 NON PHARMACOLOGICAL:-
• SURGICAL CARE
• DIET
• ACTIVITY
Treatment
2nd year: group(26) -2017- Anatomy department
Follow Up
Further outpatient Care
Continued physical
,occupational and speech
therapy maybe required
Further inpatient Care
Initial management of intra cerebral
hemorrhage generally is conducted
in the ICU
2nd year: group(26) -2017- Anatomy department
 EDUCATE PATIENTS REGARDING THE FOLLOWING:-
o TREATMENT OF HYPERTENSION
o WARNING SIGNS AND SYMPTOMS OF STROKE AS WELL AS
PREVENTING MEASURING
o TRAUMATIC BRAIN INJURY
o ADVERSE EFFECTS OF ALCOHOL AND SYMPATHOMIMETIC
SUBSTANCES
Patient Education
2nd year: group(26) -2017- Anatomy department
THANK YOU

Cerebral hemorrhage

  • 2.
     Name: AmiraEsam  Name: Reem Mohamed  Name: Hadeer Khalfalla  Name: Yossra Helal  Name: Rawda Abdelmenam  Name: Tasneem Tarek  Name: Yara Sabry  Name: Reham Abd Elhameed  Name: Alaa Maged  Name : Alaa Mohamed  Name: Walaa Shaban Designed by Under supervision of 2nd year: group(26) -2017- Anatomy department
  • 3.
    1) Anatomy ofCerebral Vessels 2) Cerebral Hemorrhage 3) Causes 4) Epidemiology 5) Stages 6) Clinical Picture 7) Investigation 8) Treatment 9) Follow UP 10)Patient Education 2nd year: group(26) -2017- Anatomy department
  • 4.
    IS AN ANASTOMOTICSYSTEM OF ARTERIES THAT SITS AT THE BASE OF THE BRAIN. • ANTERIOR CEREBRAL ARTERY • ICA • POSTERIOR COMMUNTICATING ARTERY • POSTIRIOR CEREBRAL ARTERY 2nd year: group(26) -2017- Anatomy department
  • 5.
    SUPERFICIAL SYSTEM OFVEINS :- SUPERIOR CEREBRAL VEIN MIDDLE CEREBRAL VEIN ( SUPERFICIAL & DEEP ) INFERIOR CEREBRAL VEIN DEEP SYSTEM OF VEINS :- THALAMOSTRIATE VEINS CHOROID VEINS INTERNAL CEREBRAL VEINS GREAT CEREBRAL VEIN Cerebral Veins 2nd year: group(26) -2017- Anatomy department
  • 6.
    2nd year: group(26)-2017- Anatomy department
  • 7.
     IS THEPATHOLOGICAL ACCUMULATION OF BLOOD WITHIN THE CRANIAL VAULT MAY OCCUR WITHIN BRAIN PARENCHYMA OR THE SURROUNDING MENINGEAL SPACES.  IT ACCOUNTS FOR 8-13% OF ALL STROKES .  ALSO IS MORE LIKELY TO RESULT IN DEATH OR MAJOR DISABILITY  INTRACEREBRAL HEMORRHAGE AND ACCOMPANYING EDEMA MAY DISRUPT OR COMPRESS ADJACENT BRAIN TISSUE, LEADING TO NEUROLOGICAL DYSFUNCTION.  DISPLACEMENT OF BRAIN PARENCHYMA MAY CAUSE ↑(ICP) AND FATAL HERNIATION SYNDROMES. 2nd year: group(26) -2017- Anatomy department
  • 8.
  • 9.
    • Age of55 and doubles with each deacade till 80 Age • Africans due to hypertension Race • Slight male predominance Sex Epidemiology 2nd year: group(26) -2017- Anatomy department
  • 10.
    Phase TIME HB, Location o Hyper acute < 24 h Oxyhemoglobin, intracellular oAcute 1-3 d Deoxyhemoglobin, intracellular o Early subacute >3 d Methemoglobin, intracellular o Late subacute >7 d Methemoglobin, extracellular o Chronic >14 d Ferritin and hemosiderin, extracellular Stages 2nd year: group(26) -2017- Anatomy department
  • 12.
    Altered conscio us level (50%) Headach e ( 40%) Nausea and vomiting (40%) Seizures ( 6-7%) focal numbness, tingling, or weakness Onset of symptoms of intracerebral hemorrhage is usually during daytime activity, with progressive (ie, minutes to hours) development of the following:
  • 13.
    NEUROLOGICAL SYMPTOMS ACCORDING TOSITE: Thalamus sensory loss Brain stem facial weakness Cerebellum Ataxia
  • 14.
    • ECG DIAGNOSIS:DEEP T WAVE INVERSIONS ASSOCIATED WITH INTRACRANIAL HEMORRHAGE • SPONTANEOUS CEREBRAL HEMORRHAGE IN A PATIENT WITH ESSENTIAL HYPERTENSION. • BOTH CT ANGIOGRAPHY & MR ANGIOGRAPHY HAVE PROVIDE TO BE EFFECTIVE IN THE DIAGNOSIS OF INTRACRANIAL HEMORRHAGE SO CT IS PERFORMED TO EXCLUDE A 2RY CAUSE OF HEMORRHAGE OR TO DETECT A SPOT SIGN. 2ND YEAR: GROUP(26) -2017- ANATOMY DEPARTMENT
  • 15.
    INTRAPARENCHYMAL HEMORRHAGE CANBE RECOGNIZED ON CT SCANS AS THE BLOOD APPEARS BRIGHTER THAN OTHER TISSUES ALSO THE TISSUE THAT SURROUND THE BLEED KINDA DENSE THAN THE REST OF THE BRAIN BECAUSE OF EDEMA • MAGNETIC RESONANCE IMAGING (MRI) • LUMBAR PUNCTURE (CSF EXAMINATION) • GRADIENT ECHO (GRE) 2ND YEAR: GROUP(26) -2017- ANATOMY
  • 16.
    SUBACUTE SUBDURAL HEMATOMAIN A RIGHT FRONTOPARIETAL CONCAVITY. CT SCAN (CT) SHOWS AN ISOATTENUATING-TO-HYPOATTENUATING SUBDURAL HEMATOMA. BOTH T1-WEIGHTED (T1W) AND T2-WEIGHTED (T2W) MR IMAGES SHOW HIGH SIGNAL INTENSITY SUGGESTIVE OF A LATE SUBACUTE HEMORRHAGE. 2nd year: group(26) -2017- Anatomy department
  • 17.
    THIS MRI REVEALSHEMORRHAGIC TRANSFORMATION OF AN ISCHEMIC INFARCT. 2nd year: group(26) -2017- Anatomy department
  • 18.
  • 19.
     PHARMACOLOGICAL :- •ANTIHYPERTENSIVE AGENTS • OSMOTIC DIURETICS • ANTIPYRETICS, ANALGESICS • ANTICONVULSANTS  NON PHARMACOLOGICAL:- • SURGICAL CARE • DIET • ACTIVITY Treatment 2nd year: group(26) -2017- Anatomy department
  • 20.
    Follow Up Further outpatientCare Continued physical ,occupational and speech therapy maybe required Further inpatient Care Initial management of intra cerebral hemorrhage generally is conducted in the ICU 2nd year: group(26) -2017- Anatomy department
  • 21.
     EDUCATE PATIENTSREGARDING THE FOLLOWING:- o TREATMENT OF HYPERTENSION o WARNING SIGNS AND SYMPTOMS OF STROKE AS WELL AS PREVENTING MEASURING o TRAUMATIC BRAIN INJURY o ADVERSE EFFECTS OF ALCOHOL AND SYMPATHOMIMETIC SUBSTANCES Patient Education 2nd year: group(26) -2017- Anatomy department
  • 22.