Lobar intracerebral hemorrhage

Lobar intracerebral hemorrhage
Hemorrhage lobar intracerebral haemorrhages are those that occur in subcortical white matter, ranged beyond the thalamus and basal ganglia.

 
Causes

Among the causes of lobar hemorrhage include chronic hypertension, amyloid angiopatia, bleeding diatheses, especially when combined with warfarin or heparin. If treatment with anticoagulants, the biggest risk factor for intracranial or systemic bleeding is a prolonged prothrombin time. The coexistence of hypertension also increased bleeding tendency. Cerebral haemorrhage induced by anticoagulants have several characteristics: it often develops insidiously, gradually, within hours or days, are located mainly in the cerebellum, have a high rate of morbidity and mortality, possibly small hemorrhages in 30 cm3 volume are likely to survive .

 
Other causes of lobar hemorrhage are intratumoral hemorrhage, Willis polygon aneurysms, arterio-venous malformations. There is also a segment of patients that can not be determined causes.

 
Clinical

 
The neurological signs and symptoms of sudden onset, within minutes. They depend on the location and extent of bleeding. When appearing in the occipital region homonymous hemianopsia patient presents. If interested in the dominant hemisphere temporal lobe, there is global aphasia and delirium, in case of damage to non-dominant hemisphere temporal lobe, then the anosognozia constructive apraxia. In parietal hemorrhage is a lack of interest usually sensitive to all types of sensitivity at a hemicorp, if interested in the dominant hemisphere may occur and a degree of aphasia, and if damage can meet the non-dominant constructive apraxia or mutism. In case of damage to the frontal lobe cerebral meets arms.

 
Signs of these events accompanying neurologic focal headache, neck contracture, vomiting, drowsiness, seizures. The state of coma can occur if the effect massive bleeding mass affecting the thalamus and mid-brain.

 
Diagnosis

 
Diagnosis is based on the clinical laboratory examinations in conjunction with the CT, MRI (magnetic resonance imaging), selective arteriography, angiography, focused on causes of lobar intracerebral hemorrhage.

 
Angiopatia amyloid is diagnosed at necropsy by Congo red staining. A characteristic of amyloid is that it is stored only in cerebral arteries, causing bleeding intervals spanning multiple months or years. Amyloid deposits are localized in small and medium-sized vessels. The vessels are fragile and can be microanevrisme the break. The disease affects mainly older people of 60-65 years.
Venous angioma is rarely encountered in clinical examinations were found at autopsy. It is located predominantly in the supratentorial subtentorial in the cerebellum and frontal lobe.

 
Treatment

 
It is the same as with hypertensive cerebral hemorrhage plus generating disease treatment.