Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Feb 22 2021

Parenchymal Hemorrhage

  • Snapshot
    • A 61-year-old man presents to the emergency department after his son found him somnolent at his home on the floor. The son is not sure how this event occurred. Medical history is significant for hypertension, Alzheimer dementia, and atrial fibrillation. He is currently taking lisinopril, metoprolol, donepezil, and wafarin. A CT head without contrast is performed and demonstrates a cerebellar bleed. The bed is elevated, he is given mannitol and intravenous vitamin K and fresh frozen plasma. Neurosurgery is consulted for emergent cerebellar decompression.
  • Introduction
    • Definition
      • bleeding within the brain parenchyma
  • Epidemiology
    • Risk factors
      • hypertension (most common)
      • cerebral amyloid angiopathy (second most common)
  • Pathogenesis
    • Hypertension vasculopathy
      • chronic hypertension leads to blood vessel wall thickening, leading to blood vessel rupture
      • may also form Charcot-Bouchard aneurysms, leading to an intraparechymal bleed
      • results in a basal ganglia bleed (most commonly the putamen)
      • other locations
        • thalamus
        • cerebellum
        • lobar
        • pons
    • Amyloid angiopathy
      • beta-amyloid deposits in the vessel wall, leading to blood vessel wall thickening
      • results in a lobar bleed
  • Presentation
    • Symptoms/physical examination
      • depends on location of the bleed
      • headache, nausea/vomiting, and impaired conciousness in large bleeds
        • lethargy
        • headache
        • obtundation
      • contralateral limb weakness in putamenal bleeds
      • contralateral sensory deficits in thalamic bleeds
  • Imaging
    • CT head without contrast
      • indication
        • initial imaging study in patients with changes in cognition and neurological deficits
      • findings
        • basal ganglia bleed seen in hypertensive vasculopathy
        • lobar bleed seen in amyloid angiopathy
  • Studies
    • Serum
      • coagulation studies (PTT and INR)
    • Studies
      • cardiopulmonary monitoring
      • intracranial pressure monitor in altered patients
      • electroencephalogram
  • Differential
    • Migraine headaches
      • differentiating factor
        • neurological deficits typically associated with a headache
    • Epidural hematoma
      • differentiating factor
        • convex hyperdensity that does not surpass the suture lines on head CT without contrast
  • Treatment
    • Medical
      • mannitol or hypertonic saline
        • indication
          • effectively decreased intracranial pressure
      • antiepileptic drugs
        • indication
          • used to treat seizures
      • reversal of anticoagulation
        • indication
          • used in patients who are on anticoagulation (e.g., warfarin)
        • medications
          • vitamin K and fresh frozen plasma
            • used to reverse warfarin
          • protamine sulfate
            • used to reverse heparin
    • Operative
      • cerebellar decompression
        • indication
          • in patients with a cerebellar hemorrhage
            • the cerebellum is located in a tight compartment, placing the patient at risk for cerebral herniation and death
      • open craniotomy
        • indication
          • in patients with a supratentorial hemorrhage
  • Complications
    • Cerebral herniation
    • Seizures
    • Intraventricular bleeding
1 of 0
1 of 4
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options