Hemorrhagic stroke: intracerebral hemorrhage - causes, symptoms, diagnosis, treatment, pathology
Hemorrhagic stroke: intracerebral hemorrhage - causes, symptoms, diagnosis, treatment, pathology
What is an intracerebral hemorrhagic stroke? It’s a stroke caused by intracerebral hemorrhage which is when bleeding occurs within the cerebrum.
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Content
4 -> there are two main types of stroke a
6.24 -> hemorrhagic stroke which occurs when an
8.32 -> artery ruptures and bleeds within the
10.639 -> brain and an ischemic stroke which
13.12 -> occurs when an artery gets blocked
15.92 -> hemorrhagic strokes can be further split
17.84 -> into two types an intracerebral
20.08 -> hemorrhage which is when bleeding occurs
21.84 -> within the cerebrum and a subarachnoid
24.4 -> hemorrhage which is when bleeding occurs
26.08 -> between the pia mater and the arachnoid
28.08 -> matter of the meninges the inner and
29.76 -> middle layers that wrap around the brain
32.32 -> we'll be focusing on intracerebral
34.399 -> hemorrhages which are more common an
36.96 -> intracerebral hemorrhage that involves
39.12 -> just the brain tissue is called an
41.399 -> intraperichymal hemorrhage whereas if
44.559 -> the blood extends into the ventricles of
46.48 -> the brain which stores cerebrospinal
48.399 -> fluid is called an intraventricular
50.48 -> hemorrhage
53.44 -> the brain has a few regions the most
55.36 -> obvious is the cerebrum which is divided
57.6 -> into two cerebral hemispheres each of
60.239 -> which has a cortex and outer region
62.719 -> divided into four lobes including the
64.879 -> frontal lobe the parietal lobe the
67.2 -> temporal lobe and the occipital lobe
70 -> there are also a number of additional
71.68 -> structures including the cerebellum
73.84 -> which is down below as well as the brain
75.92 -> stem which connects to the spinal cord
79.04 -> the right cerebrum controls muscles on
81.36 -> the left side of your body and vice
83.04 -> versa the frontal lobe controls movement
86.32 -> and executive function which is our
87.84 -> ability to make decisions
90 -> the parietal lobe processes sensory
92.079 -> information which lets us locate exactly
94.4 -> where we are physically and guides
96.079 -> movement in a three-dimensional space
98.799 -> the temporal lobe plays a role in
100.56 -> hearing smell memory as well as visual
104.079 -> recognition of faces and language
106.399 -> finally there's the occipital lobe which
108.399 -> is primarily responsible for vision
110.88 -> the cerebellum helps with muscle
112.64 -> coordination and balance
114.399 -> and finally there's the brain stem which
116.799 -> plays a vital role in functions like
118.88 -> heart rate blood pressure breathing
121.36 -> gastrointestinal function and
123.2 -> consciousness
124.56 -> [Music]
128.64 -> the brain receives blood from the left
130.72 -> and right internal carotid arteries as
133.04 -> well as the left and right vertebral
134.959 -> arteries which come together to form the
137.04 -> basilar artery
138.959 -> the internal carotid arteries turn into
141.12 -> the left and right middle cerebral
143.2 -> arteries which serve the latter portions
145.2 -> of the frontal parietal and temporal
147.36 -> lobes of the brain
148.72 -> each of the internal carotid arteries
150.4 -> also gives off branches called the
152.48 -> anterior cerebral arteries which serve
155.12 -> the medial portion of the frontal and
157.36 -> parietal lobes and connect with one
159.36 -> another with a short little connecting
161.36 -> blood vessel called the interior
163.04 -> communicating artery meanwhile the
165.28 -> vertebral arteries and basilar arteries
167.599 -> give off branches to supply the
169.599 -> cerebellum and the brain stem in
172 -> addition the basilar artery divides to
174.08 -> become the right and left posterior
175.92 -> cerebral artery which mainly serves the
178.64 -> occipital lobe and some of the temporal
180.879 -> lobe as well as the thalamus
183.2 -> finally the internal carotid arteries
185.44 -> each give off a branch called the
187.28 -> posterior communicating artery which
189.84 -> attaches to the posterior arteries on
192 -> each side
193.44 -> so together the main arteries and the
195.76 -> communicating arteries complete what is
198.159 -> called the circle of willis a ring where
201.04 -> blood can circulate from one side to the
203.76 -> other in case of a blockage
207.44 -> there are a few ways that an
209.04 -> intracerebral hemorrhage might happen
211.36 -> the most common one is through
212.879 -> hypertension or high blood pressure
215.599 -> hypertension can lead to various vessel
217.84 -> wall abnormalities hypertension can lead
220.4 -> to hyaline arteriolosclerosis
223.12 -> which results from hydrostatic pressure
225.28 -> pushing proteins out of the blood vessel
227.44 -> lumen and into the interstitial space
229.84 -> within the blood vessel walls
232.4 -> over time as more of these proteins
234.319 -> deposit into the walls the blood vessels
236.879 -> become more stiff and brittle and
238.959 -> therefore more vulnerable to rupture
242.72 -> hypertension can also cause tiny bulges
245.2 -> in the walls of the small arteries
247.12 -> called microaneurysms
249.84 -> these microaneurysms are called charcoal
252 -> bouchard aneurysms and they're more
254.239 -> likely to be found on small arteries
256.16 -> like lenticulostriate vessels which
258.479 -> arise from the anterior part of the
260.079 -> circle of willis and supply the basal
262 -> ganglia
265.36 -> intracerebral hemorrhages are sometimes
267.68 -> associated with arteriovenous
269.68 -> malformations which are a tangle of
271.919 -> blood vessels that directly connect an
274 -> artery to a vein
276 -> a bit like a capillary bed but with much
278.56 -> much larger blood vessels
281.199 -> over time these abnormal vessels can
283.28 -> rupture causing a hemorrhagic stroke
286.16 -> intracerebral hemorrhages are also
288.32 -> associated with conditions that damage
290 -> the arteries in the cerebrum themselves
292.32 -> like vasculitis a disease where
294.72 -> inflammation of the blood vessel walls
296.4 -> occurs vascular tumors like hemangioma
299.84 -> which is a benign vascular tumor of the
301.919 -> endothelial cells of the blood vessels
304.4 -> and cerebral amyloid angiopathy which is
307.6 -> a degenerative disease where abnormal
309.84 -> protein deposits in the walls of the
311.919 -> arterioles make them less compliant
316.16 -> intracerebral hemorrhage can also be
318.24 -> secondary arising after an ischemic
320.56 -> stroke an ischemic stroke is caused by a
323.52 -> blockage of blood flow to a part of the
325.44 -> brain and within hours it usually leads
328.08 -> to brain tissue death
330.32 -> arteries within the ischemic tissues are
332.24 -> themselves made up of endothelial cells
334.56 -> that die off and that means that if
336.639 -> there's reperfusion or return to blood
338.96 -> flow there's an increased chance that
340.88 -> the damaged blood vessels might rupture
343.039 -> causing a hemorrhage
344.96 -> if this happens there's bleeding into
346.88 -> dead tissue and it's called a
348.56 -> hemorrhagic conversion
352.24 -> regardless of the cause once there's an
354.32 -> intracerebral hemorrhage blood starts
356.4 -> spewing from the damaged blood vessels
358.16 -> creating a pool of blood
360 -> which increases pressure in the skull
361.919 -> and puts direct pressure on nearby
363.919 -> tissues and blood vessels it also means
366.72 -> that less blood is flowing downstream to
369.199 -> the cells that need it which leave the
371.12 -> downstream tissues deprived of
373.199 -> oxygen-rich blood
375.28 -> healthy tissues can die from both the
377.36 -> direct pressure and the lack of oxygen
379.52 -> within a few hours
381.44 -> increased pressure within the skull can
383.12 -> also lead to brain herniation which is
385.52 -> when the brain moves across structures
387.68 -> in the skull
389.28 -> these structures include the falx
391.28 -> cerebri which divides the two halves of
393.6 -> the brain
394.56 -> the tentorium cerebelli which divides
397.199 -> the occipital lobes from the cerebellum
399.84 -> and the foramen magnum which is the hole
402.319 -> in the base of the skull where the
403.919 -> spinal cord connects to the brain
408.08 -> stroke symptoms depend on the exact part
410.319 -> of the brain that is affected for
412.4 -> example an anterior or middle cerebral
414.8 -> artery stroke can cause numbness and
417.12 -> sudden muscle weakness
418.8 -> if a stroke affects the bronchus area
420.88 -> which is usually in the left frontal
422.72 -> lobe or the wernicke's area which is
424.8 -> usually in the left temporal lobe then
427.36 -> it can cause slurred speech or
428.96 -> difficulties understanding speech
430.56 -> respectively
432.319 -> if there's a posterior cerebral artery
434.4 -> stroke then it can affect vision
437.199 -> an acronym to remember some common
439.12 -> stroke symptoms is fast facial drooping
441.84 -> arm weakness speech difficulties and
444.319 -> time
445.28 -> time is obviously not a symptom but just
447.759 -> a reminder to get help as quickly as
449.84 -> possible to minimize cell injury and
452 -> maximize the chance of a full recovery
457.039 -> to diagnose and confirm the location in
459.36 -> size of a hemorrhagic stroke medical
461.68 -> imaging with a ct or mri can be used
465.599 -> also angiography which uses contrast
468.24 -> injected into the blood can help to
470.24 -> visualize the exact location where blood
472.479 -> accumulates in the brain tissue
476.879 -> medical treatment of an intercerebral
478.8 -> hemorrhage includes using drugs that
480.639 -> help control hypertension and relieve
482.879 -> intracranial pressure
484.56 -> in terms of surgery a craniotomy is
486.879 -> often helpful at relieving intracranial
488.879 -> pressure when there's a bleed near the
490.8 -> surface of the skull
492.479 -> in a cradiotomy part of the skull bone
494.639 -> is removed to drain any accumulated
496.639 -> blood and relieve pressure alternatively
499.68 -> if there's a bleed that's located deep
501.759 -> in the brain tissue stereotactic
504 -> aspiration can be done to aspirate off
506.4 -> blood and relieve intracranial pressure
508.879 -> stereotactic aspiration is done under a
511.28 -> ct scanner to help guide a needle to the
514.32 -> exact spot where the blood needs to be
516.399 -> drained
518.64 -> alright as a quick recap
520.479 -> an intracerebral hemorrhage is a type of
522.479 -> hemorrhagic stroke where an artery
524.24 -> breaks within the cerebrum the result is
526.72 -> a pool of blood forms which increases
529.2 -> intracranial pressure and downstream
531.04 -> tissue gets deprived of oxygen-rich
533.12 -> blood intracerebral hemorrhages can be
535.76 -> treated with medications aimed at
537.6 -> controlling the high intracranial
539.44 -> pressure as well as surgical
541.2 -> interventions like craniotomy or
543.04 -> stereotactic aspiration which can help
545.6 -> remove the pool of blood
547.44 -> the goal is to identify symptoms and to
549.6 -> re-establish blood flow to prevent
551.76 -> long-term damage
553.44 -> to help remember this a common acronym
555.76 -> is fast
556.959 -> facial drooping arm weakness speech
559.36 -> difficulties and time
565.92 -> helping current and future clinicians
567.92 -> focus learn retain and thrive learn more
580 -> you
Source: https://www.youtube.com/watch?v=1BBul_LC1cE