Basal ganglia hemorrhage

Lauren H Sansing MD (Dr. Sansing of the University of Connecticut Health Center and The Stroke Center at Hartford Hospital has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released March 28, 1995; last updated January 14, 2014; expires January 14, 2017

Overview

Basal ganglia intracerebral hemorrhage remains among the most deadly of stroke types. This update highlights some important recent clinical trial results on intracerebral hemorrhage, including blood pressure management and surgical interventions. The author discusses these advances and updates on the epidemiology and pathophysiology of intracerebral hemorrhage.

Key points

 

• Intracerebral hemorrhage is a neurologic emergency that requires immediate neuroimaging to differentiate it from acute ischemic stroke.

 

• Intracerebral hemorrhage in the basal ganglia is usually caused by hypertension.

 

• Patients presenting within the first few hours have a high risk of hemorrhage expansion and neurologic deterioration.

 

• Prognosis is based on multiple factors, including volume and location of hemorrhage, age, level of consciousness, presence of intraventricular hemorrhage, and warfarin use.

 

• Currently the only treatment is aggressive supportive care, but many clinical trials on new treatments (medical and surgical) are ongoing.

Historical note and terminology

The first cogent description of an intracerebral hemorrhage was published in 1658 by Wepfer in his treatise on apoplexy (Garrison 1969). In that article he noted both intracerebral hemorrhage and subarachnoid hemorrhage in different patients. Through the years, intracerebral hemorrhage has also been termed "cerebral hemorrhage," "intracranial hemorrhage," “hemorrhagic stroke,” and "cerebral bleed." The advent of head CT has greatly improved the localization and characterization of brain hemorrhages, and this has added to the precision of the nomenclature. Intracranial hemorrhage refers to any bleeding within the cranial vault, including subdural and epidural hematomas and subarachnoid hemorrhage. Intracerebral hemorrhage refers specifically to bleeding within the brain parenchyma. The term “hemorrhagic stroke” is best avoided as its meaning varies widely – some use this term to indicate an ischemic stroke that has had hemorrhagic conversion and others to denote a primary intracerebral hemorrhage or even subarachnoid hemorrhage.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.