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  • Updated 08.27.2021
  • Released 03.28.1995
  • Expires For CME 08.27.2024

Basal ganglia hemorrhage

Introduction

Overview

Basal ganglia hemorrhage is one of the most severe types of stroke. This update highlights important clinical trial results on the treatment of intracerebral hemorrhage, including blood pressure management and surgery.

Key points

• Intracerebral hemorrhage is a neurologic emergency that requires immediate diagnosis and treatment.

• The most common cause of basal ganglia is hypertension.

• The risk of hematoma expansion and neurologic deterioration is highest within the first few hours after presentation.

• Outcome depends on volume, location, age, level of consciousness, intraventricular extension, and warfarin use.

• Coagulopathy, if present, should be corrected.

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

• Surgical treatment has a limited role in the treatment of intracerebral hemorrhage.

• 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 (58). He described both intracerebral hemorrhage and subarachnoid hemorrhage. 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 it is vague.

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