Haemorrhage
Cerebrovascular disease that are caused by bleeding into brain tissue.
Intracranial/Intracerebral haemorrhage (ICH):
Usually from rupture of atherosclerotic vessel, congenital aneurysm or vascular malformation – no single cause, but interaction of several factors. Hypertension, high alcohol intake and low cholesterol levels increase risk. Accounts for up to 10% of strokes.
Clinical features – acute onset of headache, then neurological deficits; may loose consciousness in matter of minutes; nausea, vomiting, delirium, seizures;
Treatment – airway management; lower blood pressure; urgent neurosurgery to decompress haematoma
Most make good functional recovery, but some focal deficits may remain (similar to those in ischaemic stroke)
Subarachnoid haemorrhage (SAH):
Syndrome in which there is bleeding into the subarachnoid space. Up to 10% of strokes are due to SAH, more common cause of stroke in younger people. Trauma is common cause – spontaneous cases usually due to rupture of arterial aneurysm (aneurysms present in about 6% of population). 85% occur due to rupture of aneurysm at base of brain (circle of Willis).
Clinical features – sudden severe explosive headache (some have prodromal symptoms of several days), neck stiffness (Kernig’s sign), syncope, seizure, vomiting, photophobia; may have focal neurologic deficit, often have altered mental state; 35% fatal (12% before receiving medical attention)
Differential diagnosis – migraine headache; infection; meningitis; intracerebral haemorrhage; hypertensive headache
Treatment – surgical clipping of aneurysm; control of hypertension; nimodipine
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