Hemorrhagic stroke

 

1- Clinical pictures:

A- lens capsular hemorrhage (deep hematoma UCS):

– Acute onset with headache and quickly disorders of consciousness; Hemiplegia + conjugate deviation of the head and eyes toward the lesion

– Ventricular floods can occur characterized by generalized hypertension, seizures, signs decerebrate

– A more gradual and less severe picture can be with: Transient confusion, hemiplegia capsular hemianesthesia and HLH.

– A thalamic involvement is suspected in the predominance of sensory disorders, ipsilateral CBH and skew deviation (deviation of the eyes downwards and inwards).

B- hemorrhage intersection:

– Hemiplegia and sensory disorders HLH + + Wernicke aphasia type (if dominant hemisphere) or anosognosia and neglect (minor hemisphere)

– Changes feature in 3 steps: + deficit headache brutally installed -> regression problems in a few hours (or days!) -> Secondary aggravation by HIC (edema around the hematoma).

Hemorrhagic stroke

Hemorrhagic stroke

C- cerebellar hemorrhage:

– Start with a large sharp dizzy with inability to stand; posterior headache and vomiting

– Cerebellar syndrome; nystagmus; cranial nerves (VI, VII above).

– Risk: CT compression; aqueduct of Sylvius blocking => acute hydrocephalus; cerebellar tonsils commitment through the foramen magnum.

2- Etiology:

– HTA: the most common cause

– Etiology malformation: should be suspected if the subject <50 years, not hypertensive, unusual site of bleeding (lobar superficial); taking early and intense contrast; -> MRI and possibly arteriography are shown.

3- Prognosis:

– Mortality is higher than in ischemic stroke

– The functional prognosis is generally better than that of ischemic stroke

– The risk of secondary lobe epilepsy is higher

4- Treatment:

– Blood pressure control without making a screeching halt due to risk of worsening: nicardipine (1-5 mg / hour)

– Antioedémateuses measures: ½-sitting position, fluid restriction, hypocapnia if artificial ventilation, steroids have no interest, 20% mannitol with relay glycerol.

– Anti-epileptic treatment if seizures -> benzodiazepine

– Surgical treatment: External Diversion CSF in acute hydrocephalus; removal of a cerebellar hematoma compression; curative treatment of a vascular malformation.

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