Chapter 38 Intracerebral hemorrhage

Abstract

Publisher Summary Intracerebral hemorrhage (ICH) results from arterial bleeding directly into brain parenchyma. In defining the pathogenesis, risk factors, and clinical course of primary ICH, evidence suggests that the location of hemorrhage is important. Deep hemispheric ICH (deep ICH) is a result of rupture of small arterioles most commonly in the putamen or thalamus. Lobar intracranial hemorrhage (lobar ICH) results from rupture of small and medium-sized arteries in the hemispheric subcortical white matter and is most commonly associated with cerebral amyloid angiopathy (CAA). The prevalence of hypertension in different populations plays an important role in risk of ICH. Genetic risk factors for ICH have been implicated by studies showing increased risk conferred by having an affected family member. Dementia has generally been considered a major risk factor for CAA-related lobar ICH because of the close molecular relationship between CAA and Alzheimer's disease. Other risk factors for ICH have been examined, including cigarette smoking, alcohol consumption, and serum cholesterol. The chapter discusses the pathophysiologic features of ICH, Clinical features and diagnosis of ICH, and Treatment methods of ICH. The chapter also discusses the iatrogenic causes of ICH which includes warfarin anticoagulation, heparin, fibrinolytic agents, antiplatelet agents, and other drugs associated with ICH.