Intracerebral haemorrhage

Aetiology:

• Intracerebral haemorrhage is the cause of ~30% of strokes (the remainder being due to acute ischaemic events)
• The principal cause of intracerebral haemorrhage is rupture of a microaneurysm (Charcot-Bouchard aneurysms, 0.8-1mm in diameter)
• Occurs typically in patients with HT
• There are well-defined sites for the rupture:
• Basal ganglia
• Pons
• Cerebellum
• Subcortical white matter

• Saccular (Berry) aneurysms and arteriovenous malformations also bleed into the brain, but cause principally subarachnoid haemorrhage

Haemorrhage vs. ischaemia:

• Clinically, there is no reliable way of distinguishing between intracerebral haemorrhage and thromboembolic infarction (as both produce a sudden focal deficit)
• Intracerebral haemorrhage, however, tends to be more dramatic and accompanied by a severe headache
• Intracerebral haemorrhage is more likely to cause coma than thromboembolic stroke
• Intracerebral haemorrhage is visualised reliably by imaging almost immediately (cf. infarction, which takes time)

Management:

• The general management is as for cerebral infarction, although the immediate prognosis is worse
• Urgent neurosurgical evacuation of the clot should be considered when an intracerebral haematoma behaves as an expanding mass, causing:
• Deepening coma
• Coning

• Antiplatelet drugs and anticoagulants are contraindicated