ich , types and clinica featrue , treatment

ICH types . clincal features

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Intracranial hemorrhage
Shemil
Clinical instructor
DMWIMS
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An intracranial hemorrhage is a type of
bleeding that occurs inside the skull.
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Brain Injury
Focalanddiffuse brain injuryare ways to classifybrain
injury.
Focal injury occurs in a specific location.
Diffuse injury occurs over a more widespread area.
It is common for both focal and diffuse damage to occur
as the result of the same even
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FOCAL BRAIN INJURIES
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Classification
Types of intracranial hemorrhage are roughly grouped
into,
1.Intra-axial
2.Extra-axial.
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Intra-axial bleed
Intra-axial hemorrhage is bleeding within the brain
itself, orcerebral hemorrhage. This category includes,
Intraparenchymal hemorrhage(bleeding within the
brain tissue)
Intraventricular hemorrhage(bleeding within the
brain'sventricles)(particularly ofpremature infants).
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•Intraparenchymal hemorrhage(IPH) is one
form ofintracerebral bleeding in which there
is bleeding within brainparenchyma.
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Causes
•Sympathomimetic drug
abuse
•Moyamoya
disease(constricted blood
vessels)
•Neonatal intraventricular
hemorrhage
•Trauma
•Hypertension
•Arteriovenous
malformation
•Aneurysm rupture
•Intracranial neoplasm
•Coagulopathy(delay in
blood cloting)
•Hemorrhagic
transformation of an
ischemicstroke
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S/S
Hypertension
Fever
cardiac arrhythmias
Nuchal rigidity
Subhyaloid retinal hemorrhages
Altered level of consciousness
Anisocoria(unequal size of the eyes'
pupils)
Nystagmus(involuntary eye movement)
Focal neurological deficits
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Diagnostics
CT
MRI
Angiogram
Carotid duplex(ultrasound to check how well blood is
flowing through thecarotidarteries)
Transcranial Doppler(ultrasonography that measure the
velocity of blood flow through the brain's blood vessels by
measuring the echoes of ultrasound waves moving
transcranially)
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IVH
Intraventricular hemorrhage(IVH), also known
asintraventricular bleeding, is ableedinginto the
brain'sventricular system.
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•30% of intraventricular hemorrhage (IVH) are
primary (confined to the ventricular system) caused
by
1.Intraventricular trauma
2.Aneurysm
3.Vascular malformations
4.Tumors
•70% of IVH are secondary in nature, resulting from
an expansion of an existing intraparenchymal or
subarachnoid hemorrhage. occur in 35% of moderate
to severetraumatic brain injuries.
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Symptoms
Sudden onset of headache
Nausea and vomiting.
Alteration of the mental state and/or level of
consciousness.
Focal neurological signs are either minimal or
absent.
focal and/or generalized seizures may occur.
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Diagnostics
•CT
•MRI
•Angiogram
•Carotid duplex
•Transcranial doppler
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EMERGENCY
MANAGEMENT
• Airway managemant
• Expansion of hemorrhage and elevated B.P
• CURRENT RECOMMENDATION :
“ KEEP CEREBRAL PERFUSION PRESSURE
Between 50 to 70 mm Hg “
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ELEVATED ICP
Tracheal intubation and acute hyperventilation
Mannitol administration
Elevation of head end of bed
CSF drainage
Control Blood pressure
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Cerebellar hematoma
> 3 cm –evacuation
<1 cm-surgical removal usually unnecessary
1 cm –3cm : carefully monitored
Monitor
platelet count , PT, PTT to identify coagulopathy
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Extra-axial bleed
Extra-axial hemorrhage, bleeding that occurs within the
skull but outside of the brain tissue, falls into three
subtypes.
SAH-Subarachnoid hemorrhage
SDH-Subdural hemorrhage
EDH-Epidural hemorrhage(extradural hemorrhage)
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SAH
Subarachnoid hemorrhage is bleeding between
the arachnoid and pia mater.
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Causes & Risk factor
TBI
Spontaneously
1.Cerebral aneurysm
2.High blood pressure
3.Smoking
4.Family history
5.Alcoholism
6.Cocaineuse.
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Sign & Symptoms
Sever headache
Loss of consciousness
Severe neurologic deficits may develop and become
irreversible within minutes or a few hours.
Sensorium may be impaired & become restless.
Seizures
Usually, the neck is not stiff initially unless the cerebellar
tonsils herniate.
vomiting
Xanthochromia, yellow-tinged CSF(indicating the presence of
bilirubin in the cerebrospinal fluid occurs several hours after
bleeding
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Diagnostics
CT.
MRI.
Cerebral Angiography.
Up to 22 percent of aneurysmal subarachnoid
hemorrhages don't appear on initial imaging tests.
Lumbar Puncture.
Repeated Imaging.
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Management
• Medical
Anticonvulsant
Adequate rest
Analgesics and sedatives for headache
Antifibrinolytics( promote blood clotting by
preventing blood clots from breaking down)
Dehydrating measures for brain
LP to relieve severe headache
Surgery –aneurysm ( clipping of its neck ) /
excision of AV malformation
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SDH
Subdural hematoma(SDH) is the
bleedings between the inner layer of thedura
materand the arachnoid mater.
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Causes
Traumatic Brain Injury
shaken baby syndrome
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Sign & symptoms
Headache
Confusion
Change in behavior
Dizziness
Nausea and vomiting
Lethargy or excessive drowsiness
Weakness
Apathy
Seizure
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Diagnostics
CT
MRI
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Surgery
There are 2 widely used surgical techniques to treat
subdural haematomas:
•craniotomy–a section of the skull is temporarily
removed so the surgeoncan access and remove the
haematoma
•burr holes–a small hole is drilled into the skull
and a tube is inserted through the hole to help
drain the haematoma
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EDH
Extradural haematoma (EDH), also known as
anepidural haematoma, is a collection of blood that
forms between the inner surface of the skull and outer
layer of thedura.
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Causes
AVM
Traumatic Brain Injury
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S/S
Headache.
Nausea or vomiting.
Seizures.
Bradycardia with or without hypertension
Evidence of skull fractures
Cerebrospinal fluid (CSF) otorrhoea or rhinorrhoea.
Alteration in level of consciousness with deterioration
of the Glasgow Coma Scale (GCS) score.
Unequal pupils.
Weakness of limbs
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Treatment :
Craniotomy and clot evacuation
Antibiotics
Anticonvulsants.
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Head end elevation
Monitor BP
Pain Management
Pupil reaction.
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