Hematoma intracerebral

Hemorrhagic stroke is a result of bleeding into the brain and other spaces within the central nervous system and includes subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hematomas. 

Intracerebral Hemorrhage Trial compared three different doses and placebo. Doses were 40,80, or 160 mcg/kg or placebo given as an IV infusion over 1 to 2 minutes within 4 hours after the onset of symptoms. Hematoma growth was decreased at 24 hours, mortality was decreased at 90 days, and overall functioning was increased at 90 days. Further studies are ongoing to evaluate the role of recombinant factor Vila in ICH treatment.41... 

Hemorrhagic strokes account for 12% of strokes and include subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hematomas. Subarachnoid hemorrhage may result from trauma or rupture of an intracranial aneurysm or arteriovenous malformation. Intracerebral hemorrhage occurs when a ruptured blood vessel within the brain parenchyma causes formation of a hematoma. Subdural hematomas are most often caused by trauma. 

In subarachnoid hemorrhage due to a ruptured intracranial aneurysm or arteriovenous malformation, surgical intervention to clip or ablate the vascular abnormality substantially reduces mortality from rebleeding. The benefits of surgery are less well documented in cases of primary intracerebral hemorrhage. In patients with intracerebral hematomas, insertion of an intraventricular drain with monitoring of intracranial pressure is... 

Brooks RA, Di Chiro G, Patronas N et al (1989) MR imaging of cerebral hematomas at different field strengths theory and applications. Comput Assist Tomogr 13 194-206 Brott T, Broderick JP, Kothari R et al (1997) Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 28 1-5... 

While physicians may not recognize up to 80% of lacunes (Tuszynski et al. 1989), several clinical syndromes have been correlated with relevant lacunes detected at subsequent autopsy. Five of these are regarded as the classic lacunar syndromes pure motor hemiparesis, sensorimotor stroke, pure sensory hemiparesis, dysarthria clumsy hand syndrome, and ataxic hemiparesis (Donnan et al. 2002 Fisher 1982 Bamford 2001). Pure motor stroke is the commonest lacunar syndrome in clinical practice, while pure sensory stroke is encountered less frequently. The involvement of the face, arm and leg of one side is the characteristic feature of the first three syndromes while reductions of consciousness, cognitive or visual field defects are absent. Even though lacunar infarcts have been linked to lacunar syndromes, the latter are of course not specific for this stroke subtype and mimicked by cortical infarcts, intracerebral hematomas, and non-vascular causes (Bogousslavsky et al. 1988 Bamford 2001). 

Offenbacher H, Fazekas F, Schmidt R, Koch M, Fazekas G, Kapeller P (1996) MR of cerebral abnormalities concomitant with primary intracerebral hematomas. Am J Neuroradiol 17 573-578... 

Most of the previous studies on brain temperature monitoring were performed in neurosurgical patients with head trauma, brain tumor, or large intracerebral hematoma. Busto (10) addressed the importance of brain temperature in experimental cerebral ischemic injury. He was able to show a reduction in ischemic injury depending on the level of intraischemic brain temperatures. 

Analysis of intracranial hematomas for detecting drugs with short half-lives in individuals who survive several hours after intracranial bleeding has been recommended for establishing the cause of death. Cocaine metabolites were found in an intracerebral hematoma in a patient who apparently died due to cocaine (152). The hematoma contained ethanol 0.05% w/v and benzoylecgonine 0.43 mg/1. 

Fig. 9.3. Large intracerebral hematoma with mass effect.

Mannitol is widely used in patients with primary intracerebral hemorrhage and a depressed level of consciousness to decrease intracranial pressure and alleviate the space-occupying effect of the hematoma in a deteriorating patient, although there is a lack of randomized trials looking at clinical outcomes. 

There are four possible surgical procedures to treat intracerebral hematoma simple aspiration, craniotomy with open surgery, endoscopic evacuation and stereotactic aspiration. Open surgery remains the technique of choice at present... 

Teernstra OP, Evers SM, Fodder J et al. (2003). Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator a multicenter randomized controlled trial (SICHPA). Stroke 34 968-974... 

Intracerebral extension of the hemorrhage occurs in at least a third of patients. Patients with a large hematoma and depressed consciousness might require immediate evacuation of the hematoma, preferably preceded by occlusion of the aneurysm (Niemann et al. 2003). Alternatively, extensive craniectomy can be employed to allow expansion of the brain, as for maUgnant middle cerebral artery infarction (Smith et al. 2002). Subdural hematomas are rare but life threatening and should be removed. 

Intracerebral hematoma may cause a focal deficit and should be considered for removal if there is associated coma, clinical deterioration and brain shift. 

Niemann DB, Wills AD, Maartens NF et al. (2003). Treatment of intracerebral hematomas caused by aneurysm rupture coil placement followed by clot evacuation. Journal of Neurosurgery 99 843-847 Olafsson E, Gudmundsson G, Hauser WA (2000). Risk of epilepsy in long-term survivors of surgery for aneurysmal subarachnoid hemorrhage a population-based study in Iceland. Epilepsia 41 1201-1205... 

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