Based on current study results, surgery is no longer generally recommended (exception: cerebellar hemorrhage)! Whether surgical intervention is reasonable and promising depends on several factors: Age of the patient Extent/size of bleeding (bleeding volume). Concomitant diseases Cause of bleeding Clinical condition of the patient Localization of the bleeding Incursion of the hemorrhage into the ventricular … Cerebral Hemorrhage: Surgical Therapy
To prevent intracerebral hemorrhage, attention must be paid to reducing individual risk factors. Behavioral risk factors Pleasure food consumption Alcohol abuse (alcohol dependence) Drug use Amphetamines Crystal meth Cocaine Overweight (BMI ≥ 25; obesity) – leads to increased bleeding volume. Prevention factors In diabetics or patients at high cardiovascular risk, blood pressure should be below … Cerebral Hemorrhage: Prevention
Symptomatology is usually sudden and progressive (progressing) over minutes and hours. The differentiation between intracerebral hemorrhage (hemorrhagic apoplexy) and ischemic apoplexy, which is so important for treatment, is not possible on the basis of symptoms alone! The following general symptoms and complaints may indicate intracerebral hemorrhage: Sudden and severe headache (almost always). Decrease in vigilance … Cerebral Hemorrhage: Symptoms, Complaints, Signs
Pathogenesis (disease development) Primary intracerebral hemorrhage is caused by rupture (rupture) of vessels running in the brain parenchyma (brain substance, brain tissue) that have wall weakness. It bleeds into the brain parenchyma or into the cerebrospinal fluid space (here: cavity system in/around the brain).Long-standing hypertension (high blood pressure) promotes degeneration of the vessel walls – … Cerebral Hemorrhage: Causes
The following are the most important diseases or complications that may be contributed to by intracerebral hemorrhage: Cardiovascular system (I00-I99) Intrusion of cerebral hemorrhage into the ventricular system (cavity system in the brain) (intraventricular hemorrhage (IVB)). Occurs in up to 40% of patients with intracerebral hemorrhage. Symptoms: cephalgia (headache), vomiting (vomiting), vigilance reduction (reduction in … Cerebral Hemorrhage: Complications
Intracerebral hemorrhage is classified by etiology (cause) according to the guidelines of the German Society of Neurology: Spontaneous intracerebral hemorrhage Cryptogenic spontaneous intracerebral hemorrhage – the etiology has not yet been determined; however, it is believed that there is a cause Idiopathic spontaneous intracellular hemorrhage – this form of hemorrhage has not yet been explained … Cerebral Hemorrhage: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: Assessment of consciousness using the Glasgow Coma Scale (GCS). General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin and mucous membranes Neck vein congestion? Central cyanosis? (bluish discoloration of skin and central mucous membranes, e.g., tongue). Abdomen … Cerebral Hemorrhage: Examination
1st-order laboratory parameters-obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Electrolytes – potassium, magnesium, sodium. Fasting glucose (fasting blood sugar) Renal parameters – urea, creatinine, cystatin C or creatinine clearance, if necessary. Coagulation parameters – activated partial thrombin plastin time (aPTT), anti-factor Xa activity (aXa), ecarin … Cerebral Hemorrhage: Test and Diagnosis
Therapeutic Targets Prevention of hematoma progression (progression of bleeding; synonyms: hematoma growth; hematoma expansion) by: Blood pressure reduction Hemostatic procedures (measures to stop bleeding). If necessary, hematomevacuation (neurosurgical procedure to clear out hematoma). Avoidance of complications Securing or stabilizing the vital functions Therapy recommendations Treatment recommendations depend on the size of the intracerebral hemorrhage and … Cerebral Hemorrhage: Drug Therapy
Only imaging can distinguish between intracerebral hemorrhage (hemorrhagic apoplexy) and ischemic apoplexy (stroke due to vascular occlusion)! As soon as the patient arrives at the hospital, the medical device diagnostic examination must be performed in order to treat the patient adequately. Obligatory medical device diagnostics. Computed tomography of the skull (cranial CT, cranial CT or … Cerebral Hemorrhage: Diagnostic Tests
The patient history (medical history) represents an important component in the diagnosis of intracerebral hemorrhage. The patient is admitted to the hospital as a medical emergency. As a rule, the patient is unresponsive, so that the anamnesis interview is conducted with relatives or contact persons (= external anamnesis). Family history Are there frequent coagulation disorders, … Cerebral Hemorrhage: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Metabolic derangements, e.g., in the setting of diabetes mellitus or liver disease, in which there may be disturbances of consciousness with emesis (vomiting) Cardiovascular system (I00-I99). Extracerebral hemorrhage Epidural hematoma (synonyms: epidural hematoma; epidural hemorrhage) – bleeding into the epidural space (space between the bones of the skull and … Cerebral Hemorrhage: Or something else? Differential Diagnosis
