Induced intracranial hemorrhage

Infants (2 years of age or younger) - 4.2% solution for IV administration at a rate not to exceed 8 mEq/kg/day to guard against the possibility of producing hypernatremia, decreasing CSF pressure, and inducing intracranial hemorrhage. 

Ephedrine may cause hypertension resulting in intracranial hemorrhage. It may induce anginal pain in patients with coronary insufficiency or ischemic heart disease. Large doses of inhaled or oral salmeterol (12 to 20 times the recommended dose) have been associated with clinically significant prolongation of the QTc interval, which has the potential for producing ventricular arrhythmias. 

Hypothermia-induced coagulopathy in patients with severe TBI has important clinical implications. In addition to the intracranial hemorrhages caused by their primary traumatic injury, these patients have a 20-30% incidence of delayed posttraumatic intracranial hemorrhage. However, at least one report found that treatment with moderate hypothermia did not result in increased rates of secondary delayed intracranial hemorrhages as compared to normothermic controls (19). 

Ciclosporin-induced vasculopathy, with endothelial injury and derangement of the blood-brain barrier, is the postulated mechanism of neurological damage. Transient cerebral perfusion abnormalities, demonstrable in SPECT scans of the brain, have been suggested as a reliable indicator of ciclosporin neurotoxicity (SEDA-20, 344). Clinical symptoms as well as CT and/or MRI scans were very similar to those observed in hypertensive encephalopathy, with predominant and reversible white-matter occipital lesions (23). There was complete neurological recovery in most patients after blood pressure was normalized, and deaths due to intracranial hemorrhage are reported only exceptionally. 

Lacroix P, Portefaix O, Boucher M, Ramiandrisoa H, Dumas M, Ravon R, Christides C, Laskar M. Condition de survenue des accidents hemorragiques intracraniens des antivitamines K. [The causes of intracranial hemorrhagic complications induced by antivitamins K.] Arch Mai Coeur Vaiss 1994 87(12) 1715-19. 

Coma may be caused by a postictal state, hyperthermia, or intracranial hemorrhage resulting from cocaine-induced hypertension. 

Dissection of the internal carotid and vertebral arteries is a common cause of stroke, particularly in young patients. Although many occur due to trauma, it is estimated that over half occur spontaneously. The mechanism of stroke following arterial dissection is either by artery-to-artery embolism, by thrombosis in situ, or by dissection-induced lumenal stenosis with secondary cerebral hypoperfusion and low-flow watershed infarction. Occasionally, dissection may lead to the formation of a pseudoaneurysm as a source of thrombus formation. Vertebrobasilar dissections that extend intracranially have a higher risk of rupture leading to subarachnoid hemorrhage (SAH). ° ... 

Primary intracerebral hemorrhage is more common than subarachnoid hemorrhage, and its incidence increases with age (see Fig. 1.1). It is more frequent in Southeast Asian, Japanese and Chinese populations than in whites. The most common causes are intracranial small vessel disease, which is associated with hypertension, cerebral amyloid angiopathy and intracranial vascular malformations (Sutherland and Auer 2006). Rarer causes include saccular aneurysms, hemostatic defects, particularly those induced by anticoagulation or therapeutic thrombolysis, antiplatelet drugs, infective endocarditis, cerebral vasculitis and recreational drug use (Neiman et al. 2000 O Connor et al. 2005). 

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