Basal ganglia hemorrhage

Adrian Marchidann MD (Dr. Marchidann of SUNY Health Science Center 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 June 8, 2017; expires June 8, 2020

This article includes discussion of basal ganglia hemorrhage and deep intracerebral hemorrhage. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Basal ganglia intracerebral hemorrhage remains among the most deadly of stroke types. This update highlights some important 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.

 

• Coagulopathy, if present, should be corrected.

 

• Rapid blood pressure control is safe but does not improve the clinical outcome significantly.

 

• Clinical trials have failed to prove benefit of the surgical treatment.

 

• New endoscopic minimally invasive surgical techniques are being tested with encouraging results.

Historical note and terminology

Intracerebral hemorrhage was described for the first time in 1658 by Wepfer in his treatise on apoplexy (Garrison 1969). 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 detection, localization, and characterization of brain hemorrhages. 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.

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