Intracerebral hemorrhage

It is usually due to hypertension. The pathologic basis for hemorrhage is probably the presence of microaneurysms that develop on perforation vessel of 100 - 300 mcm in diameter in hypertensive patients. Most frequently in the basal ganglia and less commonly in the pons, thalamus, cerebellum, and cerebral white matter. Hemorrhage may extend into the ventricular system or subarachnoid space, and signs of meningeal irritation are then found.
Symptoms and signs
Consciousness is initially lost or impaired. Vomiting occurs very frequently at the onset of bleeding, and headache is sometimes present. There is generally a rapidly evolving neurologic deficit with hemiplegia or hemiparesis. Cerebellar hemorrhage may present with equilibrium.
Imaging : CT scan is important
Laboratory: blood count, platelet count, bleeding time, prothrombine and partial thromboplastin times and liver, Renal function test.
Treatment: it is generally conservative and supportive. Such therapy may include ventilatory support, blood pressure regulation, seizure prophylaxis, control of fever, osmotherapy and nutritional supplementation. Ventricular drainage may be required in patients with intrventicular hemorrhage and acute hydrocephalus. Cerebellar hemorrhage, prompt surgical evacuation of the hematoma is appropriate, because spontaneous unpredictable deterioration may otherwise lead to a fatal outcome and because operative treatment may lead to complete resolution of the clinical deficit.