neurologic disorders
Intracerebral Hemorrhage
Pathophysiology of Intracerebral Hemorrhage
Chronic arterial hypertension leads to formation of microaneurysms (Charcot-Bouchard aneurysms) in small perforating arteries, which may rupture and cause intracerebral hemorrhage. Blood from an intracerebral hemorrhage accumulates as a mass that can dissect through and compress adjacent brain tissues, causing neuronal dysfunction. Large hematomas increase intracranial pressure. Pressure from supratentorial hematomas and the accompanying edema may cause transtentorial Brain Herniation , compressing the brain stem and often causing secondary hemorrhages in the midbrain and pons. If the hemorrhage ruptures into the ventricular system (intraventricular hemorrhage), blood may cause acute hydrocephalus, which is an independent predictor for a worse outcome after intracerebral hemorrhage. Cerebellar hematomas can expand to block the 4th ventricle, also causing acute hydrocephalus, or they can dissect into the brain stem. Cerebellar hematomas that are>3 cm in diameter may cause midline shift or herniation. Herniation, midbrain or pontine hemorrhage, intraventricular hemorrhage, acute hydrocephalus, or dissection into the brain stem can impair consciousness and cause coma and death. 