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