Ictus hemorrágico, hemorragia cerebral y hemorragia subaracnoidea

Abstract

Spontaneous intracerebral hemorrhage is a collection of blood located in the brain tissue that originates from the non-traumatic breakage of a blood vessel. It represents 10% to 15% of all strokes and is associated with the greatest morbidity and mortality. The main risk factor is hypertension, but it has other causes, of note among which is amyloid angiopathy in subjects who are older as well as the use of anticoagulants. The clinical manifestations depend on the location and volume of the hemorrhage. The diagnosis is based on the medical record, a neurological examination, and performing a neuroimaging test. Treatment includes general management in the stroke unit, adequate blood pressure control, and the reversion of anticoagulation in patients who receive anticoagulant treatment. The indication of surgical treatment is exceptional and reserved for very specific cases.Subarachnoid hemorrhage is the extravasation of blood in the subarachnoid space and it represents up to 5% of strokes. The most frequent cause is rupture of an aneurysm and the mortality rate is as high as 40% of cases. Like in cerebral hemorrhage, the diagnosis is based on a clinical evaluation and neuroimaging. Treatment includes general support measures and, fundamentally, ruling out aneurysm to avoid rebleeding, which makes the prognosis significantly more severe. The treatment of choice, whenever the approach is possible, is endovascular versus surgery and aneurysm clipping. Other complications are the development of vasospasm and secondary cerebral ischemia, hydrocephalus, or epileptic seizures.