Ver el código de «Intracranial hemorrhage (main)»

==Background==
{{Intracranial hemorrhage DDX}}
{{ICH Hypertension Guidelines}}
{{ICH Coagulopathy Guidelines}}

==Clinical Features==
A history of hypertension, trauma, illicit drug abuse, or a bleeding diathesis may be elicited.
*Acute onset, with rapid clinical deterioration (within minutes-hours)
*Alteration in level of consciousness (approximately 50%)
*Nausea and vomiting (approximately 40-50%): but rarely at the onset
*Headache (approximately 40%)
*Seizures (approximately 6-7%)
*Anisocoria
*Focal neurological deficits

With the progression of hematoma, development of intracranial hypertension (See also [[brain herniation syndromes]]):
*Coma
*Respiratory failure
*Hypertension, bradicardia, TWI (T Waves inversion)
*Central hyperthermia

===Focal neurological deficits===
''Related to the area involved''
*'''Putamen'''
**Contralateral hemiplegia
**Contralateral sensory loss
**Aphasia
**Dysphagia
**Head and gaze deviation towards "healthy limbs"
**Homolateral mydriasis
**Homonymous hemianopia
**Neglect or apraxia
*'''Caudate nucleus'''
**Contralateral hemiparesis
**Contralateral conjugate gaze paresis
**Confusion
**Hydrocephalus (intraventricular extension of haemorrhage)
*'''Thalamus'''
**Contralateral sensory loss, with or without contralateral hemiparesis
**Vertical gaze paresis
**Confusion, aphasia
**Homonymous hemianopia
**Possible hydrocephalus
*'''Brain stem'''
**Onset with coma, quadriparesis, gaze paresis and autonomic instability
**Ocular bobbing, miosis
**Cranial nerves deficit
*'''Cerebellum''': Close monitoring!
**Ataxia, usually beginning in the trunk
**Dizziness
**Homolateral dysmetria
**Dysphagia, dysartria
**Ipsilateral facial weakness, sensory loss
**Gaze paresis, skew deviation, miosis, or decreased level of consciousness
*'''Lobar''': Exclude cerebral AVM.
**Contralateral hemiparesis or sensory loss
**Contralateral conjugate gaze paresis
**Homonymous hemianopia
**Abulia, aphasia, neglect, or apraxia

==Differential Diagnosis==
{{Intracranial mass DDX}}
{{Head trauma DDX}}

==Evaluation==
{{Head trauma workup}}



'''Diagnostic approach for ICH'''<ref>AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015)</ref>
*A baseline severity score should be performed as part of the initial evaluation of patients with ICH (Class I; Level of Evidence B)
*Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH (Class I; Level of Evidence A)
*CTA and contrast-enhanced CT may be considered to help identify patients at risk for hematoma expansion (Class IIb; Level of Evidence B), and CTA, CT venography, contrast-enhanced CT, contrastenhanced MRI, magnetic resonance angiography and magnetic resonance venography, and catheter angiography can be useful to evaluate for underlying structural lesions including vascular malformations and tumors when there is clinical or radiological suspicion (Class IIa; Level of Evidence B).

<gallery mode="packed">
File:Intracerebral heamorrage.jpg|[[Hemorrhagic stroke]] (spontaneous intracranial hemorrhage)
File:EpiduralHematoma.jpg|[[Epidural hemorrhage]]
File:Subduralandherniation.png|[[Subdural hemorrhage]]
File:SubarachnoidP.png|[[Subarachnoid hemorrhage]]
</gallery>


'''ECG role''' ([[elevated intracranial pressure]])<ref>https://litfl.com/raised-intracranial-pressure-ecg-library/</ref>
**Diffuse T-wave inversions
**Prolonged QT
**Bradycardia (the Cushing reflex – indicates imminent brainstem herniation)
*Other possible ECG changes that may be seen:
*ST segment elevation / depression — this may mimic myocardial ischaemia or pericarditis.
*Increased U wave amplitude.
*Other rhythm disturbances: sinus tachycardia, junctional rhythms, premature ventricular contractions, atrial fibrillation.


[[File:STE in TBI.jpg|thumb|STE in Traumatic Brain Injury. No cardiac injury / abnormality to explain the ST elevation]]
[[File:TWI in SAH.jpg|thumb|T Waves inversion in subarachnoid hemorrhage]]

==Management==
{{ICH Treatment}}

==Disposition==
*Admit

==External Links==
*[http://www.mdcalc.com/intracerebral-hemorrhage-ich-score/ MDCalc: ICH Score]

==See Also==
*[[Altered Mental Status]]
*[[Head trauma (main)]]
*[[Brain herniation syndromes]]
*[[EBQ:Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial]]
*[[EBQ:INTERACT-2]]

[[Category:Neurology]]
[[Category:Trauma]]

==References==
<references/>