Intracerebral (Intraparenchymal) Haemorrhage

Spontaneous intraparenchymal haemorrhage without underlying structural abnormality; causes approximately 10% of strokes

Aetiology

  • Hypertension is the most common cause - rupture of microaneurysms and degeneration of small, deep, penetrating arteries are the principal pathologies
  • Cerebral amyloid angiopathy
  • Secondary - arteriovenous malformations, cavernomas, aneurysms and dural venous thrombosis

Pathophysiology

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Clinical presentation

  • At the bedside, there is no entirely reliable way of distinguishing between haemorrhage and ischaemic infarcts
  • Intracerebral haemorrhage is more often associated with severe headache or coma
  • Patients on oral anticoagulants should be assumed to have had a haemorrhage unless it is proved otherwise

Investigations

  • Imaging - CT brain, CTA, DSA, MRI

Management

  • Essentially supportive
  • Surgical decompression probably most beneficial to the well but deteriorating patient with lobar haemorrhage