questions 2

Parenchymal Hemorrhage

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Topic updated on 10/05/17 9:00am

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


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