11/6/14 ICH 2

We will continue learning about ICH today. Hopefully this will amplify our knowledge about it. 

1) Dural sinus thrombosis with associated bleed is associated with hyper coagulable states, dehydration, Crohn's disease, and post partum period.

2) Dural sinus thrombosis with associated bleed requires full dose anticoagulation, even with hemorrhage present.

3) Most common primary tumors associated with ICH are GBM, oligodendroglioma, pituitary adenoma. The most common metastatic tumors associated with ICH are pulmonary, melanoma, thyroid, renal and choriocarcinoma.

4) Vasculopathy associated bleed are usually preceded by months of headaches, seizures, cognitive decline, psychiatric symptoms, and multiple strokes.

5) Ischemic stroke with hemorrhagic transformation is typically heterogenous on arterial distribution, commonly associated with an embolic strokes with repercussion.

6) About 38% will have a 33% increase in ICH size within 3 hours of onset of ICH

7) ICH pattern in MRI T1 - T2 "I Bleed, I Die, Bleed Die, Bleed Bleed, Die Die" Bleed: Bright. Die=Dark

8) Angiography is indicated for ICH with SAH, vascular malformations, isolated IVH, abnormal calcifications, and blood in unusual locations 

9) ICP monitoring may be helpful in patients with decreased LOC, or IVH (particularly IVH in the third or fourth ventricle)

10) Patients with cerebellar ICH > 3cm who are deteriorating neurologically or have brainstem compression and/or hydrocephalus from ventricular obstruction should have surgical removal as soon as possible.