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Lobar intracerebral hemorrhage

Lobar intracerebral hemorrhage causes

With the improvement of methods for control of hypertension (high blood pressure) among the population increases the relative proportion of hemorrhage outside the basal ganglia and thalamus. On imaging (MRI or CT) of the brain, these "lobar hemorrhage" have the appearance of oval or round of blood clots in the subcortical white matter of the brain. The role of chronic hypertension in their origin is controversial judgments. In many cases, a history of patients with no indications of high blood pressure. Almost 50% of patients can identify other causes of the similar shape and location of hemorrhage:

  • the most common arteriovenous malformation (AVM, angioma, hemangioma)
  • hemorrhagic diathesis, often arising in the application of warfarin
  • hemorrhage into the tumor, often in melanoma
  • the circle of Willis aneurysm pointing up, so that bleeding occurs in the brain substance
On brain MRI shows a hematoma in the left frontal lobe with edema of the brain tissue of vascular nature.

But quite often the cause of lobar intracerebral hemorrhage remains unknown even after a thorough examination of the patient, including selective angiography with contrast (arteriography).

In such cases, the most common amyloid angiopathy, a diagnosis which can be put in the post-mortem study, exhibiting positive staining vessels of the brain tissue dye (Congo red). Amyloid - a glycoprotein, which has properties similar to starch. Amyloid deposits in the arteries of the brain. When amyloid angiopathy cerebrovascular amyloid does not accumulate in any other organs. Excessive accumulation of amyloid in the tissues of internal organs occurs in amyloidosis.

Amyloid angiopathy is often the cause of lobar hemorrhage in the elderly. Often, patients with multiple cerebral hemorrhages occur, but the spacing between individual episodes with usually reaches months.

Most of lobar hemorrhages in size relatively small. They cause neurological disorders are limited in their manifestations. Often they resemble pulmonary embolism, which supplies one part of the brain. More massive hemorrhage, resulting in the emergence of consciousness impairment in a patient (stupor, coma), are the cause of more pronounced neurological deficits, affecting one or more lobes of the brain.

The majority of patients with lobar hemorrhages are experiencing a headache at the local hemorrhages located in the region:

  • eck - a headache around the eye or on the affected side
  • temple - a headache or around the ear forward on the same side
  • forehead - a headache in the forehead area or diffusely in the anterior quadrant
  • top of the head - a headache in the temple

At the beginning of lobar hemorrhage in a patient sometimes observed rigidity of the muscles zadnesheynyh or seizures. More than 50 % of patients vomiting or drowsiness. Neurological syndrome appears suddenly, within one or a few minutes, but not instantaneously, as is the case with occlusion of the lumen of blood vessels of the brain (embolism).

MRI of the brain in the left hemisphere of the cerebellum shows a fresh and old hemorrhage with fluid level in a patient who received anticoagulants for the treatment of chronic thrombosis of venous sinus.

Clinically neurological syndromes correspond to the localization of hematoma:

  • hemorrhage in the occipital brain share the main manifestation of neurological deficit is the loss of half the visual field (hemianopsia)
  • in the left temporal lobe of the brain - speech disorder (aphasia) and consciousness (delirium)
  • in the parietal lobe of the brain - loss of sensitivity than half of the body (hemi-type), similar to that at the thalamic lesion
  • in the frontal lobe of the brain - muscle weakness, arm (paresis)

With distribution area of hemorrhage associated with the appearance of additional, but less marked neurological symptoms.

Lobar intracerebral hemorrhage symptoms diagnosis

In most cases, the patient shows angiography, but urgent basis can not detect small vascular malformations. If you suspect a vascular malformation repeat angiography 2-4 months after the vessels that are near the clot burden undergo decompression.

Selective cerebrovascular angiography procedure (internal carotid artery)

 

Lobar intracerebral hemorrhage treatment

Treatment of lobar hemorrhage determined by the shape of damage that caused hemorrhage.

Surgical removal of the hematoma with lobar hemorrhage in patients who are conscious or in a state of drowsiness, gives a slight advantage compared with conservative therapy. Conservative treatment includes restricting fluid intake, administration of corticosteroids and, if necessary - small doses of osmotic diuretics (mannitol).

Patients who are in a stupor or coma, and do not respond quickly to medical treatment on intracranial pressure, should be carried out without delay surgical intervention. The aim of surgery is decompression of the brain with the removal of intracerebral blood clots.

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