Hemorrhagic stroke pathophysiology: Difference between revisions
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Intracerebral hemorrhage (ICH) is bleeding directly into the brain tissue, forming a gradually enlarging [[hematoma]] (pooling of blood). The hematoma enlarges until pressure from surrounding tissue limits its growth, or until it decompresses by emptying into the [[ventricular system]], [[cerebrospinal fluid|CSF]] or the [[pia]]l surface. A third of intracerebral bleed is into the brain's ventricles. ICH has a [[mortality rate]] of 44 percent after 30 days, higher than ischemic stroke or even the very deadly subarachnoid hemorrhage.<ref name="caplan">{{cite journal | author= Caplan LR | title= Intracerebral hemorrhage | journal= Lancet | year=1992 | pages=656-8 | volume=339 | issue=8794 | id=PMID 1347346}}</ref> | Intracerebral hemorrhage (ICH) is bleeding directly into the brain tissue, forming a gradually enlarging [[hematoma]] (pooling of blood). The hematoma enlarges until pressure from surrounding tissue limits its growth, or until it decompresses by emptying into the [[ventricular system]], [[cerebrospinal fluid|CSF]] or the [[pia]]l surface. A third of intracerebral bleed is into the brain's ventricles. ICH has a [[mortality rate]] of 44 percent after 30 days, higher than ischemic stroke or even the very deadly subarachnoid hemorrhage.<ref name="caplan">{{cite journal | author= Caplan LR | title= Intracerebral hemorrhage | journal= Lancet | year=1992 | pages=656-8 | volume=339 | issue=8794 | id=PMID 1347346}}</ref> | ||
Hypertensive Intracerebral hemorrhage ICH usually results from spontaneous rupture of a small artery deep in the brain. | |||
The most common sites include: | |||
[[*Basal ganglia]] (especially the [[putamen]]) | |||
*[[Thalamus]] | |||
*[[Cerebellum]] | |||
*[[Pons]] | |||
The small arteries in these areas seem more sensitive to hypertension and as a result, it may progress to vascular injury. | |||
If intracerebral hemorrhage (ICH) occurs in other brain areas or in non hypertensive patients, the other causes of [[intracerebral hemorrhage]] should be considered such as: | |||
*Neoplasms | |||
Cerebral amyloid angiopathy | |||
*Hemorrhagic disorders | |||
*Vascular malformations | |||
===Subarachnoid hemorrhage=== | ===Subarachnoid hemorrhage=== | ||
[[Subarachnoid hemorrhage]] is considered a stroke when it occurs spontaneously (not result from external forces and head trauma). | [[Subarachnoid hemorrhage]] is considered a stroke when it occurs spontaneously (not result from external forces and head trauma). | ||
Revision as of 20:24, 2 November 2016
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Hemorrhagic stroke Microchapters |
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Diagnosis |
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Treatment |
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AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) |
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AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012) |
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AHA/ASA Guideline Recommendation for the Primary Prevention of Stroke (2014) |
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AHA/ASA Guideline Recommendations for Prevention of Stroke in Women (2014) Sex-Specific Risk Factors
Risk Factors Commoner in Women |
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Case Studies |
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Hemorrhagic stroke pathophysiology On the Web |
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American Roentgen Ray Society Images of Hemorrhagic stroke pathophysiology |
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Risk calculators and risk factors for Hemorrhagic stroke pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
A hemorrhagic stroke, or cerebral hemorrhage, is a form of stroke that occurs when a blood vessel in the brain ruptures or bleeds. Like ischemic strokes, hemorrhagic strokes interrupt the brain's blood supply because the bleeding vessel can no longer carry the blood to its target tissue. In addition, blood irritates brain tissue, disrupting the delicate chemical balance, and, if the bleeding continues, it can cause increased intracranial pressure which physically impinges on brain tissue and restricts blood flow into the brain. In this respect, hemorrhagic strokes are more dangerous than their more common counterpart, ischemic strokes. There are two types of hemorrhagic stroke: intracerebral hemorrhage, and subarachnoid hemorrhage. Amphetamine abuse quintuples, and cocaine abuse doubles, the risk of hemorrhagic strokes.
Intracerebral Hemorrhage
Intracerebral hemorrhage (ICH) is bleeding directly into the brain tissue, forming a gradually enlarging hematoma (pooling of blood). The hematoma enlarges until pressure from surrounding tissue limits its growth, or until it decompresses by emptying into the ventricular system, CSF or the pial surface. A third of intracerebral bleed is into the brain's ventricles. ICH has a mortality rate of 44 percent after 30 days, higher than ischemic stroke or even the very deadly subarachnoid hemorrhage.[1] Hypertensive Intracerebral hemorrhage ICH usually results from spontaneous rupture of a small artery deep in the brain. The most common sites include: *Basal ganglia (especially the putamen)
The small arteries in these areas seem more sensitive to hypertension and as a result, it may progress to vascular injury. If intracerebral hemorrhage (ICH) occurs in other brain areas or in non hypertensive patients, the other causes of intracerebral hemorrhage should be considered such as:
- Neoplasms
Cerebral amyloid angiopathy
- Hemorrhagic disorders
- Vascular malformations
Subarachnoid hemorrhage
Subarachnoid hemorrhage is considered a stroke when it occurs spontaneously (not result from external forces and head trauma).
A spontaneous hemorrhage in the brain usually results from:
- Sudden rupture of an aneurysm in an artery in the brain
- Congenital aneurysms
- Secondary to prolonged hypertension (occurs when an artery branches in a weakened area of artery's wall)
- Rupture of an abnormal connection between arteries and veins (arteriovenous malformation AVM)
- Inflamed artery
- (Septic emboli) travels to an artery that supplies the brain, and causes inflammation and as a result the inflamed artery may weaken and rupture
References
- ↑ Caplan LR (1992). "Intracerebral hemorrhage". Lancet. 339 (8794): 656–8. PMID 1347346.