Intracerebral hemorrhage

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Intracerebral hemorrhage

Pathology

Central nervous system disorders

Spina bifida

Chiari malformation

Dandy-Walker malformation

Syringomyelia

Tethered spinal cord syndrome

Aqueductal stenosis

Septo-optic dysplasia

Cerebral palsy

Spinocerebellar ataxia (NORD)

Transient ischemic attack

Ischemic stroke

Intracerebral hemorrhage

Epidural hematoma

Subdural hematoma

Subarachnoid hemorrhage

Saccular aneurysm

Arteriovenous malformation

Broca aphasia

Wernicke aphasia

Wernicke-Korsakoff syndrome

Kluver-Bucy syndrome

Concussion and traumatic brain injury

Shaken baby syndrome

Epilepsy

Febrile seizure

Early infantile epileptic encephalopathy (NORD)

Tension headache

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Idiopathic intracranial hypertension

Trigeminal neuralgia

Cavernous sinus thrombosis

Alzheimer disease

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Torticollis

Essential tremor

Restless legs syndrome

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Multiple sclerosis

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Brain abscess

Epidural abscess

Cavernous sinus thrombosis

Creutzfeldt-Jakob disease

Central and peripheral nervous system disorders

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Autonomic nervous system disorders

Orthostatic hypotension

Horner syndrome

Nervous system pathology review

Congenital neurological disorders: Pathology review

Headaches: Pathology review

Seizures: Pathology review

Cerebral vascular disease: Pathology review

Traumatic brain injury: Pathology review

Spinal cord disorders: Pathology review

Dementia: Pathology review

Central nervous system infections: Pathology review

Movement disorders: Pathology review

Neuromuscular junction disorders: Pathology review

Demyelinating disorders: Pathology review

Adult brain tumors: Pathology review

Pediatric brain tumors: Pathology review

Neurocutaneous disorders: Pathology review

Assessments

Intracerebral hemorrhage

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Intracerebral hemorrhage

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USMLE® Step 1 style questions USMLE

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An 82-year-old woman is brought to the emergency department for evaluation of sudden onset left-sided weakness and lethargy. The patient lives at home with her son, who found the patient lethargic and unable to move the left side of her body. The son states over the past year, the patient has been forgetting names of common people as well as losing her abilities to perform activities of daily living.  She recently became lost in the parking lot of a grocery store she has been shopping at for decades. She has no past medical history. Her temperature is 37°C (98.6°F), pulse is 101/min and regular, and blood pressure is 171/94 mmHg. The patient appears somnolent but is arousable to voice and pain. Physical examination reveals marked weakness of the left upper and left lower extremity with associated decreased sensation in the left arm and leg. The patient’s eyes are currently deviated towards the right. A noncontrast CT of the head is shown below:


Reproduced from: Radiopaedia  

Which of the following best describes the most likely etiology of this patient’s clinical presentation?   

External References

First Aid

2016

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Transcript

Contributors

Filip Vasiljević, MD

Evan Debevec-McKenney

Vincent Waldman, PhD

There are two main types of stroke: a hemorrhagic stroke, which occurs when an artery ruptures and bleeds within the brain, and an ischemic stroke, which occurs when an artery gets blocked.

Hemorrhagic strokes can be further split into two types, an intracerebral hemorrhage which is when bleeding occurs within the cerebrum, and a subarachnoid hemorrhage which is when bleeding occurs between the pia mater and arachnoid mater of the meninges - the inner and middle layers that wrap around the brain.

We’ll be focusing on intracerebral hemorrhages which are more common.

An intracerebral hemorrhage that involves just the brain tissue is called an intraparenchymal hemorrhage, whereas if the blood extends into the ventricles of the brain which store cerebrospinal fluid, it’s called an intraventricular hemorrhage.

OK - let’s start with some basic brain anatomy. The brain has a few regions - the most obvious is the cerebrum, which is divided into two cerebral hemispheres, each of which has a cortex - an outer region - divided into four lobes including the frontal lobe, parietal lobe, temporal lobe, and the occipital lobe.

There are also a number of additional structures - including the cerebellum, which is down below, as well as the brainstem which connects to the spinal cord.

The right cerebrum controls muscles on the left side of your body and vice versa.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Hemorrhagic transformation after cerebral infarction: current concepts and challenges" undefined (2014)
  6. "Intracerebral and subarachnoid hemorrhage in patients with cancer" Neurology (2010)
  7. "Intracranial Hemorrhage" Emergency Medicine Clinics of North America (2012)
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