Neurology Exam Prep Podcast Episode 27 - Intracranial Hemorrhage
Jan 2, 2021
In this insightful discussion, Dr. Jennifer Kim, a neurocritical care attending, shares her expertise on intracranial hemorrhage, particularly intracerebral hemorrhage. She delves into the nuances of hypertensive hemorrhages and their imaging characteristics, the impact of vascular malformations like AVMs and aneurysms, and the role of anticoagulation in increasing hemorrhagic risk. Key topics include the management of ICH and surgical interventions, alongside prognostic scoring and critical care strategies. A must-listen for neurology residents!
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Deep Locations Suggest Hypertensive Bleeds
- Hypertensive intraparenchymal hemorrhages preferentially occur in deep brain structures like basal ganglia, thalamus, brainstem, and deep cerebellum.
- Location plus history of long-standing hypertension helps infer hypertensive etiology.
Different Malformations, Different Bleed Patterns
- Vascular malformations (AVMs, cavernomas, aneurysms) each have distinct imaging patterns and bleeding behaviors.
- AVMs bleed under higher pressure into parenchyma, cavernomas cause localized low-pressure bleeds, and aneurysms more often cause subarachnoid hemorrhage.
Choose Imaging By Suspected Lesion
- Use CTA to identify aneurysms and AVMs and MRI (T2) to detect cavernous malformations.
- Look for CTA 'spider web' vascular tangle for AVM and 'popcorn' T2 appearance for cavernoma.