Intracerebral hemorrhage
also known as Cerebral hemorrhage.
Its a subtype of intracranial hemorrhage that occurs within the brain tissue itself, also called intraaxial hemorrhage.
Epidemiology
Classification
Etiology
Pathophysiology
Diagnosis
Volume
Scores
Treatment
Outcome
Complications
Retrospective cohort studies
This retrospective cohort study aims to establish a risk model based on the epidemiological and clinical characteristics of intracerebral hemorrhage patients to help identify their critical care needs.
The clinical data of ICH patients from January 2018 to September 2023 were analyzed retrospectively in the First Affiliated Hospital of Soochow University, China. The full cohort was used to derive the clinical prediction model, which was internally validated with bootstrapping. Discrimination and calibration were assessed using the area under the curve (AUC) and the Hosmer-Lemeshow tests, respectively.
Results: 611 patients with ICH were included for model development. 61.21% (374/611) of ICH patients had received critical care interventions. The influencing factors included in the model were the Glasgow Coma Scale (GCS) score, intraventricular hemorrhage, past blood pressure control, systolic blood pressure on admission, and bleeding volume. The model's goodness-of-fit was evaluated, which yielded a high area under the curve (AUC) value of 0.943, indicating a good fit. For model validation, a cohort of 260 patients with ICH was utilized. The model demonstrated a Youden's index of 0.750, with a sensitivity of 90.56% and a specificity of 78.22%.
GCS, systolic blood pressure, intraventricular hemorrhage, bleeding volume, and past blood pressure control are the main factors affecting the critical care needs of patients with ICH. This study has deduced a clinical predictive model with good discrimination and calibration to provide scoring criteria for clinical health care providers to accurately evaluate and identify the critical care needs of ICH patients, to improve the rational integration and allocation of medical resources 1).
Case series
Intracerebral Hemorrhage with Intraventricular Extension: A Case Report
Authors: [Your Name], MD, Neurosurgery Department, Hospital General Universitario de Alicante
Abstract
Intracerebral hemorrhage (ICH) with intraventricular extension is a critical neurological emergency associated with poor prognosis. This case report describes a 78-year-old female patient presenting with acute neurological deterioration due to a hypertensive hemorrhage centered in the right mesencephalon with intraventricular extension. Despite medical management, the extensive nature of the hemorrhage led to a decision against surgical intervention, and a protocol for limiting life-sustaining therapies was initiated.
Case Presentation
Patient Information
- Age/Sex: 78-year-old female
- Medical History: Not available (suspected hypertension)
- Presenting Symptoms: Decreased level of consciousness, left-sided hemiplegia, non-verbal state, and anisocoria (left > right)
- Time of Last Known Well: 12 hours prior to admission
Emergency Evaluation
- Neurological Exam: Stuporous, localizing to pain, left-sided hemiplegia with Babinski sign, and non-reactive left mydriasis
- Initial Management: Code stroke activated, urgent CT performed
- Imaging Findings:
- Non-contrast Cranial CT:
- Right mesencephalic and thalamic hemorrhage (31×18 mm)
- Associated vasogenic edema
- Intraventricular extension (blood in lateral ventricles, third, and fourth ventricle)
- No hydrocephalus (Evans index 0.3)
- No midline shift
- CT Angiography:
- No vascular malformations, aneurysms, or arterial stenosis
- Dolichoectasia of the basilar artery
Clinical Course
- Day 1: The patient was transferred to the ICU for ventilatory support due to progressive neurological deterioration.
- Day 3:
- Neurological Status: Glasgow Coma Scale 7 (E1, M5, V1), no sedation or opioids for >24h
- Respiratory Status: On mechanical ventilation (PS 10/7, FiO2 0.5)
- Hemodynamic Status: Stable but hypertensive
- Infectious Status: Isolated for E. coli BLEE (rectal swab positive)
- Other Systems: Enteral feeding tolerated, no significant gastrointestinal findings
Management & Outcome
- Neurosurgical Considerations: Given the poor prognosis, no surgical intervention was recommended.
- Prognostic Discussion: Due to the severity of neurological damage and the extension of hemorrhage, the medical team and the family agreed on a limitation of life-sustaining therapies. The patient remained on supportive care without escalation of treatment in case of further deterioration.
Discussion
Primary hypertensive intracerebral hemorrhage is a leading cause of stroke-related morbidity and mortality. Hemorrhages involving the mesencephalon and thalamus with intraventricular extension pose a high risk for neurological decline and poor functional recovery. Current guidelines recommend conservative management unless there is significant hydrocephalus or mass effect requiring external ventricular drainage. In this case, despite the absence of hydrocephalus, the severe neurological impairment and extensive hemorrhage led to the decision of non-escalation of care.
Conclusion
This case illustrates the poor prognosis associated with hypertensive hemorrhages extending into the ventricular system and highlights the importance of individualized management decisions in critically ill neurosurgical patients. The role of early prognostication and family discussions is essential in guiding appropriate care.
Keywords
- Hypertensive stroke
- Neurosurgical decision-making
- Neurocritical care