Causes include hypertension, neoplasm, vasculitis, coagulopathy and mycotic aneurysms associated with bacterial endocarditis.
Clinical features include sudden onset coma, drowsiness and/or neurological deficit. Headache usually occurs only with cortical and intraventricular haemorrhage. The rate of evolution depends on the size and size of the bleed. The area affected is the putamen (55%), thalamus (10%), cerebral cortex (15%), pons (10%) and cerebellum (10%).
CT scan is the definitive test. A coagulation and vasculitis blood screen may be indicated. Angiography is indicated if surgical repair is contemplated though not for drainage of blood clot.
• Supportive (e.g. hydration, nutrition, analgesia, ventilatory support)
• Blood pressure control (maintain systolic BP <220-230 mmHg)
• Correct any coagulopathy
• Control raised intracranial pressure
• Surgery—contact Regional Centre, e.g. for evacuation of haematoma, repair/clipping of aneurysm
• Steroid therapy is ineffective
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