Hypertensive intracerebral hemorrhage
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Hypertensive intracerebral haemorrhages are common. In fact, hypertension is the most common cause of intracerebral haemorrhages. They can be conveniently divided according to their typical locations which include, in order of frequency:
- basal ganglia haemorrhage (especially the putamen)
- thalamic haemorrhage
- pontine haemorrhage
- cerebellar haemorrhage
Pathology
Long-standing poorly controlled hypertension leads to a variety of pathological changes in the vessels.
- microaneurysms of perforating arteries (Charcot-Bouchard aneurysms)
- small (0.3-0.9 mm) diameter
- occur on small (0.1-0.3 mm) diameter arteries
- distribution which matches incidence of hypertensive haemorrhages
- 80% lenticulostriate
- 10% pons
- 10% cerebellum
- found in hypertensive patients
- may thrombose, leak (see cerebral microhaemorrhages) or rupture 2
- accelerated atherosclerosis: affects larger vessels
- hyaline arteriosclerosis
- hyperplastic arteriosclerosis: seen in very elevated and protracted cases
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Treatment and Prognosis
Hemorrhage causes displacement of brain tissue, but once resorbed, patient recovers with fewer deficits compared to similar-sized infarcts. Characteristics of hypertensive hemorrhages that lead to poorer prognosis include 3:
- bleed in the posterior fossa
- large amount of mass effect
- extension into the ventricular system
-</ul><p>{{youtube:http://www.youtube.com/watch?v=d8G7zEXzKRk}}</p>- +</ul><p>{{youtube:http://www.youtube.com/watch?v=d8G7zEXzKRk}}</p><h4>Treatment and Prognosis </h4><p>Hemorrhage causes displacement of brain tissue, but once resorbed, patient recovers with fewer deficits compared to similar-sized infarcts. Characteristics of hypertensive hemorrhages that lead to poorer prognosis include <sup>3</sup>: </p><ul>
- +<li>bleed in the posterior fossa </li>
- +<li>large amount of mass effect </li>
- +<li>extension into the ventricular system </li>
- +</ul>
References changed:
- 3. Jeffrey Klein, Jennifer Pohl, Emily N. Vinson et al. Brant and Helms' Fundamentals of Diagnostic Radiology. (2018) ISBN: 9781496367389 - <a href="http://books.google.com/books?vid=ISBN9781496367389">Google Books</a>
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