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1、BaselSharaf,HMSIIIGillianLieberman,MDMarch2005IntracerebralHemorrhage:anatypicalpresentationBaselSharaf,HarvardMedicalSchoolGillianLieberman,MDBaselSharaf,HMSIIIGillianLieberman,MDIntracerebralHemorrhage(ICH)°Definition:°BrainParenchymalbloodcollectionsecondary
2、tolocallossofvascularintegrity2BaselSharaf,HMSIIIGillianLieberman,MDICHonGrossPathologyCoronalgrosspathologyfromanelderlypatientwhodiedfromspontaneousICHsecondarytoamyloidangiopathy3DiagnosticImaging:Brain,1sted,2004BaselSharaf,HMSIIIGillianLieberman,MDIntracer
3、ebralHemorrhage(ICH)°Epidemiology:°Accountsfor10-15%ofallstrokes°Incidence15per100,000°Highestmortalityrateofallstrokesubtypes°Medianageof56yearsvs.ischemicstroke65years4BaselSharaf,HMSIIIGillianLieberman,MDIntracerebralHemorrhage(ICH)°PrimaryICH:°80%ofallcases
4、°Chronichypertension°Amyloidangiopathy5BaselSharaf,HMSIIIGillianLieberman,MDIntracerebralHemorrhage(ICH)°SecondaryICH:°AVmalformation°Intracranialneoplasm(primaryormetastatic)°Cavernousangioma°Venousangioma°Cerebralvenousthrombosis°Coagulaopathy(inherent/drug)°
5、Vasculitis°Cocaine/alcoholabuse°Conversionfromischemicstroke6BaselSharaf,HMSIIIGillianLieberman,MDIntracerebralHemorrhage(ICH)°Clinicalpresentation:°Symptoms:°Acutefocalneurologic°Headache(40%)deterioration;varieswith°Vomiting(50%)clotsizeandlocation°↓Conscious
6、ness(50%)°60%ofpatientshave°↑Bloodpressure(90%)symptomprogression°Seizures(10%)°40%ofpatientshavemaximalsymptomsatonset7BaselSharaf,HMSIIIGillianLieberman,MDIntracerebralHemorrhage(ICH)8www.uptodate.comBaselSharaf,HMSIIIGillianLieberman,MDIntracerebralHemorrhag
7、e(ICH)°CTFindings:°Acute:Hyperdensemass°IsodenseifHgb<8-10g/dl°Fluid-fluidlevelswithcoagulopathy/thrombolytictherapy°Subacute:isodensemass(1-6weeks)°Chronic:hypodensemass9BaselSharaf,HMSIIIGillianLieberman,MDIntracerebralHemorrhage(ICH)LocationEtiologyPutamen(2
8、8-42%)HTN(90%)Thalamus(10-26%)HTN(90%)Lobar(19-30%)Allothercauses(65%)HTN(35%)Cerebellum(8-15%)HTN(85%)Brainstem(4-11%)HTN(85%)10BaselSharaf,HMSIIIGillianLieberman,MDPatient
