Intracranial hemorrhage (main) - Revision history

Danbot: Strip excess bold

2026-03-22T09:26:23Z

Strip excess bold

← Older revision		Revision as of 09:26, 22 March 2026
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	===Focal neurological deficits===		===Focal neurological deficits===
	''Related to the area involved''		''Related to the area involved''
	*~~'''~~Putamen~~'''~~		*Putamen
	**Contralateral hemiplegia		**Contralateral hemiplegia
	**Contralateral sensory loss		**Contralateral sensory loss
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	**Homonymous hemianopia		**Homonymous hemianopia
	**Neglect or apraxia		**Neglect or apraxia
	*~~'''~~Caudate nucleus~~'''~~		*Caudate nucleus
	**Contralateral hemiparesis		**Contralateral hemiparesis
	**Contralateral conjugate gaze paresis		**Contralateral conjugate gaze paresis
	**Confusion		**Confusion
	**Hydrocephalus (intraventricular extension of haemorrhage)		**Hydrocephalus (intraventricular extension of haemorrhage)
	*~~'''~~Thalamus~~'''~~		*Thalamus
	**Contralateral sensory loss, with or without contralateral hemiparesis		**Contralateral sensory loss, with or without contralateral hemiparesis
	**Vertical gaze paresis		**Vertical gaze paresis
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	**Homonymous hemianopia		**Homonymous hemianopia
	**Possible hydrocephalus		**Possible hydrocephalus
	*~~'''~~Brain stem~~'''~~		*Brain stem
	**Onset with coma, quadriparesis, gaze paresis and autonomic instability		**Onset with coma, quadriparesis, gaze paresis and autonomic instability
	**Ocular bobbing, miosis		**Ocular bobbing, miosis
	**Cranial nerves deficit		**Cranial nerves deficit
	*~~'''~~Cerebellum~~'''~~: Close monitoring!		*Cerebellum: Close monitoring!
	**Ataxia, usually beginning in the trunk		**Ataxia, usually beginning in the trunk
	**Dizziness		**Dizziness
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	**Ipsilateral facial weakness, sensory loss		**Ipsilateral facial weakness, sensory loss
	**Gaze paresis, skew deviation, miosis, or decreased level of consciousness		**Gaze paresis, skew deviation, miosis, or decreased level of consciousness
	*~~'''~~Lobar~~'''~~: Exclude cerebral AVM.		*Lobar: Exclude cerebral AVM.
	**Contralateral hemiparesis or sensory loss		**Contralateral hemiparesis or sensory loss
	**Contralateral conjugate gaze paresis		**Contralateral conjugate gaze paresis
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	~~'''~~Diagnostic approach for ICH~~'''~~<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015)</ref>		Diagnostic approach for ICH<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015)</ref>
	*A baseline severity score should be performed as part of the initial evaluation of patients with ICH (Class I; Level of Evidence B)		*A baseline severity score should be performed as part of the initial evaluation of patients with ICH (Class I; Level of Evidence B)
	*Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH (Class I; Level of Evidence A)		*Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH (Class I; Level of Evidence A)
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	~~'''~~ECG role~~'''~~ ([[elevated intracranial pressure]])<ref>https://litfl.com/raised-intracranial-pressure-ecg-library/</ref>		ECG role ([[elevated intracranial pressure]])<ref>https://litfl.com/raised-intracranial-pressure-ecg-library/</ref>
	**Diffuse T-wave inversions		**Diffuse T-wave inversions
	**Prolonged QT		**Prolonged QT

Rossdonaldson1: /* Evaluation */

2021-02-04T17:28:53Z

Evaluation

← Older revision		Revision as of 17:28, 4 February 2021
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	<gallery mode="packed">		<gallery mode="packed">
	File:Intracerebral heamorrage.jpg\|[[Hemorrhagic stroke]] (spontaneous intracranial hemorrhage)		File:Intracerebral heamorrage.jpg\|[[Hemorrhagic stroke]] (spontaneous intracranial hemorrhage)
	File:~~Epidural Hematoma~~.jpg\|[[Epidural hemorrhage]]		File:EpiduralHematoma.jpg\|[[Epidural hemorrhage]]
	File:Subduralandherniation.png\|[[Subdural hemorrhage]]		File:Subduralandherniation.png\|[[Subdural hemorrhage]]
	File:SubarachnoidP.png\|[[Subarachnoid hemorrhage]]		File:SubarachnoidP.png\|[[Subarachnoid hemorrhage]]

Rossdonaldson1: /* Evaluation */

2020-01-23T19:13:13Z

Evaluation

← Older revision		Revision as of 19:13, 23 January 2020
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	==Evaluation==		==Evaluation==

	{{Head trauma workup}}		{{Head trauma workup}}

Rossdonaldson1: /* Evaluation */

2020-01-23T19:12:48Z

Evaluation

← Older revision		Revision as of 19:12, 23 January 2020
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	*Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH (Class I; Level of Evidence A)		*Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH (Class I; Level of Evidence A)
	*CTA and contrast-enhanced CT may be considered to help identify patients at risk for hematoma expansion (Class IIb; Level of Evidence B), and CTA, CT venography, contrast-enhanced CT, contrastenhanced MRI, magnetic resonance angiography and magnetic resonance venography, and catheter angiography can be useful to evaluate for underlying structural lesions including vascular malformations and tumors when there is clinical or radiological suspicion (Class IIa; Level of Evidence B).		*CTA and contrast-enhanced CT may be considered to help identify patients at risk for hematoma expansion (Class IIb; Level of Evidence B), and CTA, CT venography, contrast-enhanced CT, contrastenhanced MRI, magnetic resonance angiography and magnetic resonance venography, and catheter angiography can be useful to evaluate for underlying structural lesions including vascular malformations and tumors when there is clinical or radiological suspicion (Class IIa; Level of Evidence B).



	<gallery mode="packed">		<gallery mode="packed">

Rossdonaldson1: /* Clinical Features */

2020-01-23T19:12:14Z

Clinical Features

← Older revision		Revision as of 19:12, 23 January 2020
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	==Clinical Features==		==Clinical Features==

	A history of hypertension, trauma, illicit drug abuse, or a bleeding diathesis may be elicited.		A history of hypertension, trauma, illicit drug abuse, or a bleeding diathesis may be elicited.
	*Acute onset, with rapid clinical deterioration (within minutes-hours)		*Acute onset, with rapid clinical deterioration (within minutes-hours)
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	*Focal neurological deficits		*Focal neurological deficits

	With the progression of ~~haematoma~~, development of intracranial hypertension (See also [[brain herniation syndromes]]):		With the progression of hematoma, development of intracranial hypertension (See also [[brain herniation syndromes]]):
	*Coma		*Coma
	*Respiratory failure		*Respiratory failure
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	*Central hyperthermia		*Central hyperthermia

	Focal neurological deficits ~~are in relation with~~ the area involved:		===Focal neurological deficits===
			''Related to the area involved''
	*'''Putamen'''		*'''Putamen'''
	**Contralateral hemiplegia		**Contralateral hemiplegia

Luca.ratibondi: /* Evaluation */

2020-01-09T11:07:14Z

Evaluation

← Older revision		Revision as of 11:07, 9 January 2020
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	[[File:STE in TBI.jpg\|~~400px~~\|STE in Traumatic Brain Injury. No cardiac injury / abnormality to explain the ST elevation]]		[[File:STE in TBI.jpg\|thumb\|STE in Traumatic Brain Injury. No cardiac injury / abnormality to explain the ST elevation]]
	[[File:TWI in SAH.jpg\|~~400px~~\|T Waves inversion in subarachnoid hemorrhage]]		[[File:TWI in SAH.jpg\|thumb\|T Waves inversion in subarachnoid hemorrhage]]

	==Management==		==Management==

Luca.ratibondi: /* Evaluation */

2020-01-09T10:49:36Z

Evaluation

← Older revision		Revision as of 10:49, 9 January 2020
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	*Other rhythm disturbances: sinus tachycardia, junctional rhythms, premature ventricular contractions, atrial fibrillation.		*Other rhythm disturbances: sinus tachycardia, junctional rhythms, premature ventricular contractions, atrial fibrillation.

	~~<gallery>~~
	~~TWI in SAH.jpg\|TWI in SAH~~		[[File:STE in TBI.jpg\|400px\|STE in Traumatic Brain Injury. No cardiac injury / abnormality to explain the ST elevation]]
	STE in TBI.jpg\|STE in Traumatic Brain Injury. No cardiac injury / abnormality to explain the ST elevation		[[File:TWI in SAH.jpg\|400px\|T Waves inversion in subarachnoid hemorrhage]]
	~~</gallery>~~

	==Management==		==Management==

Luca.ratibondi: /* Evaluation */

2020-01-09T10:44:35Z

Evaluation

← Older revision		Revision as of 10:44, 9 January 2020
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	{{Head trauma workup}}		{{Head trauma workup}}



	'''Diagnostic approach for ICH'''<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015)</ref>		'''Diagnostic approach for ICH'''<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015)</ref>

Luca.ratibondi: /* Evaluation */

2020-01-09T10:42:24Z

Evaluation

← Older revision		Revision as of 10:42, 9 January 2020
Line 64:		Line 64:

	==Evaluation==		==Evaluation==

	{{Head trauma workup}}		{{Head trauma workup}}

	*~~In [[elevated intracranial pressure]] ECG may show:~~		'''Diagnostic approach for ICH'''<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015)</ref>
	**~~Diffuse T~~-~~wave inversions~~		*A baseline severity score should be performed as part of the initial evaluation of patients with ICH (Class I; Level of Evidence B)
	**Prolonged QT		*Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH (Class I; Level of Evidence A)
			*CTA and contrast-enhanced CT may be considered to help identify patients at risk for hematoma expansion (Class IIb; Level of Evidence B), and CTA, CT venography, contrast-enhanced CT, contrastenhanced MRI, magnetic resonance angiography and magnetic resonance venography, and catheter angiography can be useful to evaluate for underlying structural lesions including vascular malformations and tumors when there is clinical or radiological suspicion (Class IIa; Level of Evidence B).



	<gallery mode="packed">		<gallery mode="packed">
	File:Intracerebral heamorrage.jpg\|[[Hemorrhagic stroke]] (spontaneous intracranial hemorrhage)		File:Intracerebral heamorrage.jpg\|[[Hemorrhagic stroke]] (spontaneous intracranial hemorrhage)
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	File:Subduralandherniation.png\|[[Subdural hemorrhage]]		File:Subduralandherniation.png\|[[Subdural hemorrhage]]
	File:SubarachnoidP.png\|[[Subarachnoid hemorrhage]]		File:SubarachnoidP.png\|[[Subarachnoid hemorrhage]]
			</gallery>


			'''ECG role''' ([[elevated intracranial pressure]])<ref>https://litfl.com/raised-intracranial-pressure-ecg-library/</ref>
			**Diffuse T-wave inversions
			**Prolonged QT
			**Bradycardia (the Cushing reflex – indicates imminent brainstem herniation)
			*Other possible ECG changes that may be seen:
			*ST segment elevation / depression — this may mimic myocardial ischaemia or pericarditis.
			*Increased U wave amplitude.
			*Other rhythm disturbances: sinus tachycardia, junctional rhythms, premature ventricular contractions, atrial fibrillation.

			<gallery>
			TWI in SAH.jpg\|TWI in SAH
			STE in TBI.jpg\|STE in Traumatic Brain Injury. No cardiac injury / abnormality to explain the ST elevation
	</gallery>		</gallery>

Luca.ratibondi: /* Clinical Features */

2020-01-09T10:25:18Z

Clinical Features

@@ Line 5: / Line 5: @@
 ==Clinical Features==
 *See also [[brain herniation syndromes]]
 ==Differential Diagnosis==

← Older revision		Revision as of 17:28, 4 February 2021
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	<gallery mode="packed">		<gallery mode="packed">
	File:Intracerebral heamorrage.jpg\|[[Hemorrhagic stroke]] (spontaneous intracranial hemorrhage)		File:Intracerebral heamorrage.jpg\|[[Hemorrhagic stroke]] (spontaneous intracranial hemorrhage)
	File:~~Epidural Hematoma~~.jpg\|[[Epidural hemorrhage]]		File:EpiduralHematoma.jpg\|[[Epidural hemorrhage]]
	File:Subduralandherniation.png\|[[Subdural hemorrhage]]		File:Subduralandherniation.png\|[[Subdural hemorrhage]]
	File:SubarachnoidP.png\|[[Subarachnoid hemorrhage]]		File:SubarachnoidP.png\|[[Subarachnoid hemorrhage]]