20 Intracranial Bleeding

ICP

Causes

Symptoms

  • HTN and ICP increase

  • lesion above red nucleus: decorticate
  • lesion below red nucleus: decerebrate

GCS

Herniation

  • Subfalcine: 3, cingulate gyrus goes under false cerebri
  • Uncal: 1, medial temporal lobe uncus goes down
  • Central: 2, diencephalon goes down against midbrain
  • Tonsillar: 5

Subfalcine

  • left lesion, left side knocked out, right leg paresis

Uncal

  • tentorium: dura matter above cerebellum

  • can get false localizing sign, opposide side compression

Transtentorial

  • uncal one subtype of transtentorial
  • central: 2, thalamus/hypothalamus/etc all herniates

Tonsilar

  • usually fatal

Bleeding

Epidural

  • arterial bleed

  • 3rd branch is middle meningeal

  • skull fracture

  • lucid interval: severe, knocked out, then conscious again

Subdural

SAH

  • very suddenly

Hemorrhagic

  • ischemic stroke sites different from intraparenchymal bleeding. Most common ischemic is MCA

  • putamen stroke affects IC, thalamus, FEF

Charcot-Bouchard

Cerebral Amyloid Angiopathy

IVH