Snapshot A 69-year-old male with atrial fibrillation on warfarin and hypertension had a syncopal episode and struck his head on the stairs. Shortly thereafter, he because unconsious. A CT is performed Introduction A hemorrhage within the brain parenchyma Common bleeding sites include: basal ganglia internal capsule thalamus cerebellum Causes include: hypertension leads to hemorrhage in basal ganglia, thalamus, cerebellum, pons trauma AVM coagulopathy tumors amyloid angiopathy in the elderly leads to lobar hemorrhage Presentation Symptoms lethargy headache obtundation Physical exam focal motor and sensory deficits Evaluation Immediate head CT/MRI without contrast Hypodensity Look for mass effect or focal edema that may predict a herniation Differential Hemorrhagic stroke, trauma, meningitis, and migraine headache Treatment Prevent elevation of ICP: raising the head of the bed limiting fluids treating hypertension giving calcium channel blockers (nimodipine) If ICP increased: Mannitol Hyperventilate Steroids Ventricular shunt