Friday, 23 January 2009

Where are the common sites of intracerebral bleeds?

Sorry, a lightening strike near my place has eliminated my usual internet access, and so I'm having to patch something together using my cell phone! Apologies therefore for the lack of posts over the last few days, and for any lack of editing you may now be seeing... oh well.

Strokes can be either thrombotic (80%) or haemorrhagic (20%). Of the haemorrhagic ones, three quarters are intracerebral (the rest are subarachnoid haemorrhages). The commonest cause of an intracerebral bleed is chronic hypertension, which seems to particularly damage and weaken the small penetrating arteries deep in the brain.

In terms of location, any site is possible, but as you might expect, some are more popular than others. The most likely areas are the basal ganglia (putamen, thalamus especially) and adjacent white matter, the deep cerebellum, and the pons. In fact, when intracerebral bleeds occur in other areas, you should more strongly consider a diagnosis other than hypertension.

Other causes of intracerebral bleeds are cerebral amyloid angiopathy (degeneration and amyloid deposition in elderly patients), arteriovenous malformations, cocaine use, head injury, anticoagulant therapy (and bleeding disorders in general), and a haemorrhage into a brain tumour. This list obviously isn’t exhaustive, but is more than enough.

Source: Harrison’s Principles of Internal Medicine (16th edn.)

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