Spontaneous Intracerebral Hemorrhage & Saccular “Berry” Aneurysms

Spontaneous Intracerebral Hemorrhage

  • Sites
    • Basal ganglia > thalamus > white matter > pons > cerebellum
  • Morphology
    • No large areas of necrosis (vs. infarcts)
    • May dissect into ventricles, subarachnoid space
    • Duret hemorrhage if herniation occurs

Ultimately resorbed leaving fluid filled cavity

Hemorrhage_GR

Saccular “Berry” Aneurysms

  • Less common than ICH
  • Most common cause of spontaneous subarachnoid hemorrhage
  • Affects 1% of population
    • Polycystic kidney disease, fibromuscular dysplasia, coarctation of aorta, arteriovenous malformation
  • Congenital defect of arterial wall (media) at branch points (80%)
  • Site
    • 80% at bifurcations of anterior circulation
    • 15-20% posterior circulation
    • 25% multiple
  • Manifestations
    • Local mass effect
    • Rupture into subarachnoid space
    • Rupture into brain
    • Secondary infarcts due to arterial spasm
  • Presentation
    • Younger females (< 50)
    • Abrupt onset of signs of raised intracranial pressure
    • Meningeal signs (bloody CSF)
  • Complications
    • 50% die within days
    • Infarcts after 4-9 days
    • Herniation
    • Hydrocephalus (organization may cause obstruction)

aneurysmpict  cirwillis02

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