11/5/14 ICH

Well, day by day ... learning 10 things at a time, each day we are more knowledgeable about stroke and hopefully this will translate in saving more lives and providing better medical care to our patients. 

1) Intracerebral hemorrhage (ICH) has the highest mortality rate among stroke types (30-50%) 

2) ICH is more common among men, the elderly, AA, Japanese, and people with low low density LDL cholesterol. 

3) Hypertension is the most modifiable risk factor. 

4) Hypertensive bleed

• Basal ganglia (40-50%), lobar regions (20-50%), thalamus (10-15%), ponds (5-12%), cerebellum (5-10%) 
• IVH occurs in 1/3 of cases commonly related to thalamic or caudate ICH that ruptures into the ventricle.

5) Amyloid angiopathy

• Age >60 yo, b-amyloid deposition, may have history of Alzheimer's dementia, 
• Apo E2 and E4 alleles are more commonly associated with CAA
• Multicompartmental bleeds (ICH + SAH, ICH+SDH)
• Recurrent ICH

6) Coagulopathy related ICH usually causes multifocal bleeds. Cerebellar vermis is a common location.

7) AVM bleed rate is 2-4% per year with a recurrent bleeding of 6-18%. 

8) Cavernous hemangioma bleed rate is 0.25-1.1% per year in the anterior circulation with a rebleeding rate of 4.5% year. In the posterior fossa, the year bleeding rate is 2-3% with a 21% rebleeding rate. 

9) Cavernous hemangioma is associated with CCM-1, CCM-2 and PDCD-10 mutations.

10) Cavernous hemangioma has a multiple "popcorn" gradient echo appearance.