Intracerebral Hemorrhage

The intracerebral hemorrhage is a focal bleeding from a blood vessel in the brain parenchyma. The most common cause is hypertension. Typical symptoms include focal neurological deficits, often with sudden incipient headache, nausea and impaired consciousness. The diagnosis is made by CT or MRI. The treatment includes blood pressure checks, supportive measures and in some patients the surgical removal.

Most intracerebral hemorrhage occur in the basal ganglia, the cerebral lobes, the cerebellum and pons. Cerebral hemorrhage can also occur in other parts of the brain stem or in the midbrain.

The intracerebral hemorrhage is a focal bleeding from a blood vessel in the brain parenchyma. The most common cause is hypertension. Typical symptoms include focal neurological deficits, often with sudden incipient headache, nausea and impaired consciousness. The diagnosis is made by CT or MRI. The treatment includes blood pressure checks, supportive measures and in some patients the surgical removal. Most intracerebral hemorrhage occur in the basal ganglia, the cerebral lobes, the cerebellum and pons. Cerebral hemorrhage can also occur in other parts of the brain stem or in the midbrain. Etiology The intracerebral hemorrhage is usually caused by the rupture of a small atherosclerotic artery which has a wall weakness, v. a. in chronic arterial hypertension. Such bleeding is usually great, einzelnd and catastrophic in its effects. Other modifiable risk factors that contribute to atherosclerotic hypertensive intracerebral hemorrhage are smoking, obesity and a high-risk diet (z. B. high in saturated fats, trans fats, and calories). Cocaine use, or in some cases also the use of other sympathomimetic drugs may cause temporary severe hypertensive derailments that cause bleeding. Rare based intracerebral haemorrhage in a congenital aneurysm, arteriovenous or other vascular malformations (vascular lesions in the brain), trauma (craniocerebral injury (TBI)), a mycotic aneurysm, cerebral infarction (hemorrhagic infarction), primary or metastatic brain tumors, excessive anticoagulation, impaired blood composition, intracranial arterial dissection, moyamoya disease or a bleeding disorder, or vasculitis. Vascular lesions in the brain Widespread vascular lesions in the brain arteriovenous malformations and aneurysms. Arteriovenous malformations (AVM): AVM are intertwined, dilated blood vessels; the arteries open it directly into the veins. AVM occur most often at branches of cerebral arteries, usually in the parenchyma of the frontoparietal region of the frontal lobe, the lateral cerebellum or the overlying occipital lobe. AVMs can also occur within the dura. AVM can both bleeding and compress brain tissue directly; this can lead to seizures or ischemia. Through brain imaging, they can be found by accident; Contrast or non-enhanced CT usually recognize AVM with a diameter> 1 cm but is done to confirm the diagnosis by MRI. Occasionally indicated a cranial bruit indicate a AVM. For the final diagnosis and the decision whether the lesion is operable, conventional angiography is needed. Superficial AVM with a diameter> 3 cm are usually using a combination of micro-surgery, radiosurgery, and eliminates endovascular surgery. The treatment of deep-seated or AVM is from AVM with a diameter <3 cm using stereotactic radiosurgery, endovascular therapy (z. B. preoperative embolization or thrombosis via an intra-arterial catheter) or coagulation with targeted proton radiation. (See also Recommendations for the management of intracranial arteriovenous malformations of the Stroke Council, American Stroke Association.) Aneurysms: Aneurysms are focal sacs in arteries. They come before the people at about 5%. Common factors that contribute to atherosclerosis can, hypertension and hereditary diseases of the connective tissue (e. B. Ehlers-Danlos syndrome, pseudoxanthoma elasticum, autosomal dominant polycystic kidney disease). Occasionally, septic emboli cause mycotic aneurysms. Brain aneurysms usually have a diameter <2.5 cm and are sack-shaped (not fusiform); sometimes they have one or more small, thin-walled, protuberances (berry aneurysm). Most aneurysms occur along the middle cerebral artery and the anterior cerebral artery or the communicating branches of the circle of Willis, and in particular to arterial bifurcations. Mycotic aneurysms usually develop distal to the first fork in the arterial branches of the circle of Willis. Many aneurysms are asymptomatic, only a few cause symptoms by compression of adjacent structures. Eye muscle paralysis, diplopia, strabismus or pain in the eye sockets may indicate that pressure on the III., IV., V. and VI. Cranial nerves is applied. Vision loss and a bitemporaler visual field defect may be signs of pressure on the optic chiasm. Aneurysms can Bleeding into the subarachnoid space and cause a subarachnoid hemorrhage. Before rupture, aneurysm occasionally cause "sentinele" (warning) headache due to a painful expansion of the aneurysm or blood exiting into the subarachnoid space. The current rupture itself leads to sudden, severe headache, which is called "thunderclap headache" (thunderclap headache). Sack shaped aneurysm with permission of the publisher. From Knight A., L. Hayman, Charletta D. In Atlas of Cerebrovascular Disease. Edited by P. B. Gorelick and M.A. Sloan. Philadelphia, Current Medicine, 1996. var model = {thumbnailUrl: '/-/media/manual/professional/images/saccular_aneurysm_high_de.jpg?la=de&thn=0&mw=350' imageUrl: '/ - / media / manual / professional / images / saccular_aneurysm_high_de.jpg lang = en & thn = 0 ', title:'? sack shaped aneurysm 'description:' u003Ca id = "v38396809 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = ""para "" u003e u003cp u003eIn this magnetic resonance angiogram is a small saccular aneurysm in the horizontal right middle cerebral artery visible (arrow). u003c / p u003e u003c / div u003e 'credits 'with permission of the publisher. From Knight A.

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