Intracerebral hemorrhage as described may be secondary to an underlying lesion such as an aneurysm or arteriovenous malformation, but 'spontaneous' or 'primary' intracerebral hemorrhage forms a further subgroup. It most commonly occurs in the basal ganglia area ( Fig 4), often secondary to hypertension. Lobar hemorrhages are also common and may be secondary to amyloid angiopathy. Coagulation disorders, tumors, and drug abuse are rarer causes of 'primary intracerebral hemorrhage'.
Fig. 4 CT brain scan showing 'typical' hypertensive intracerebral hemorrhage in the left putaminal area. The hemorrhage is causing significant mass effect, with midline shift and has also ruptured into the lateral ventricular system.
Apart from the first few hours following ictus, rebleeding is not a common problem and so surgical intervention generally concerns evacuation of the clot only. Herein lies controversy. Probably apart from the rapidly deteriorating patient, there is little agreement about if and when surgical evacuation should be performed ( Fernandes and Mendejow.1997).
As this type of hemorrhage is more common in the older patient, assessment of the general medical condition is an important part of preoperative preparation. The recognition that many hematomas are secondary to anticoagulation or antithrombotic treatment indicates that care should be taken to perform clotting studies, particularly if no history is available from the unconscious or dysphasic patient.
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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...