5. INTRA AXIAL HEMORRAGE- INTRA PARENCHYMAL
- INTRA VENTRICULAR
EXTRA AXIAL HEMORRHAGE
– EPIDURAL HEMORRHAGE
- SUBDURAL HEMORRHAGE
- SUBARACHNIOD HEMORRHAGE
6. INTRA PARENCHYMAL HEMORRHAGE
1. AETIOLOGY
A)
B)
C)
D)
E)
Hypertension
Trauma
Cerebral amyloid angiopathy
Advanced age
Cocaine and methamphetamine use
13. •
•
•
•
Ocular disturbances
Deviation of eyes downward & inward
Unequal pupils with absence of light reactions
Ipsilateral horner’s syndrome
Paralysis of vertical gaze,nystagmus
14. Pontine hemorrhage
• Deep coma with quadriplegia over few
minutes
• Pin point pupil reacting to light
• Impaired reflex horizontal eye movements
• Hyperpnoea,hyperhydrosis,hypertension are
common
16. • Paresis of conjugate lateral gaze to the side of
hemorrhage
• Ipsilateral 6th nerve palsy
• Dysphagia,dysarthria
17. Cerebellar hmrg…
• Later stage –
BRAIN STEM COMPRESSION/HYDROCEPHALUS
IMMEDIATE EVACUATION CAN BE LIFE SAVING !!
18. LOBAR HEMORRHAGE
• occipital hemorrhage - hemianopia;
• left temporal hemorrhage,-aphasia and
delirium;
• parietal hemorrhage - hemisensory loss;
• frontal hemorrhage,-arm weakness
• Focal headache and vomiting can occur
19.
20.
21.
22.
23.
24. Cerebral amyloid angiopathy
• Elderly
• arteriolar degeneration and
amyloid deposition
• most common cause of lobar
hemorrhage in the elderly
25.
26. • intracranial hemorrhages associated with
IV thrombolysis given for MI
• patients who present with multiple
hemorrhages (and infarcts) over several
months or years
• patients with "micro-bleeds" seen on brain
MRI sequences sensitive for hemosiderin
27. • pathologic demonstration of Congo red
staining of amyloid in cerebral vessels
• no specific therapy, although antiplatelet
and anticoagulating agents are typically
avoided.
32. • Hemorrhage into a brain tumor may
be the first manifestation of neoplasm
I. Choriocarcinoma,
II. malignant melanoma,
III. renal cell carcinoma, and
IV. bronchogenic carcinoma
are among the most common metastatic
tumors associated with ICH
39. Venous anomalies
• As a result of anomalous
cerebral, cerbellar / brainstem
venous drainage
• Are functional venous channels
• Surgery – risk of venous infarction
and hemorrhage
59. • Most common – tempero parietal region
• VESSELS :
1. Anterior & Posterior branches of
middle meningeal artery
2. Middle meningeal vein
‘’ lucid interval present ‘’
60. Kernohan’s notch effect
•
EDH – RAISED ICP
CONING OF SUPRATENTORIAL CONTENT THROUGH THE
TENTORIAL HIATUS
SHIFT OF MIDBRAIN TO THE OPPOSITE SIDE – INJURED BY
SHARP END OF TENTORIUM CEREBELLI
61. CORTICOSPINAL TRACT ON OPPOSITE SIDE
BEFORE DECUSSATION GETS INJURED
HEMIPARESIS AND PUPILLARY CHANGES ON
THE SIDE OF HEMATOMA
62.
63.
64. C/F
• h/o trauma/ fall…Transient loss of
consciousness..lucid interval…regain
consciousness
• Pupillary changes – hutchinsonian pupil
• Features of raised ICP
65. • X RAY & CT are diagnostic
• Immediate surgical intervention is life saving
• Complications – meningitis, post traumatic
amnesia,post traumatic epilepsy
71. C/F
•
•
•
•
Features of raised ICP
SIGNS OF MENINGEAL IRRITATION
CRANIAL NERVES- 3,4,6
Pressure effect on surrounding structures
72. management
• Medical – adequate rest
- analgesics and sedatives for headache
-antifibrinolytics prevent rebleeding
-dehydrating measures for brain
-LP to relieve severe headache
Surgery – aneurysm ( clipping of its neck ) /
excision of AV malformation
after 6-14 days