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
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)