Neurology · MU Sofia

61. Parenchymal brain haemorrhage

Covers bleeding directly into the brain tissue from ruptured cerebral vessels, described as the most common form of haemorrhagic stroke. It lists primary causes such as hypertension and amyloid angiopathy alongside secondary causes like malformations, aneurysms, anticoagulants and trauma, then follows the pathogenesis through to raised intracranial pressure. Typical hypertensive and lobar sites, clinical features, examination findings, CT and MRI diagnosis, differential diagnoses, acute treatment, surgical indications and complications are also set out.

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Topic 61 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 246 words (2 min of reading), with 16 flashcards.

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  1. Parenchyma brain haemorrhage

Parenchyma brain haemorrhage

Definition: Intracerebral (parenchymal) hemorrhage is bleeding directly into the brain parenchyma due to rupture of cerebral blood vessels. It is the most common type of hemorrhagic stroke.

Etiology

1.Primary Causes: Arterial hypertension (most common). Cerebral amyloid angiopathy (elderly)

2.Secondary Causes: Arteriovenous malformations (AVMs). Aneurysms. Anticoagulant therapy. Brain tumors. Coagulation disorders. Head trauma. Vasculitis

Pathogenesis

Vessel rupture → blood accumulates in brain tissue → mass effect + cerebral edema → increased intracranial pressure (ICP) → neuronal damage and possible brain herniation.

Common Locations

  • Hypertensive Hemorrhages: Basal ganglia (putamen) – most common. Thalamus. Pons. Cerebellum
  • Lobar Hemorrhages: Frontal. Parietal. Temporal. Occipital lobes

Clinical Features

  • Sudden Onset: Severe headache. Vomiting. Rapid neurological deterioration
  • Focal Neurological Deficits: Contralateral hemiparesis/hemiplegia. Hemisensory loss. Aphasia (dominant hemisphere). Visual field defects
  • Signs of Increased ICP: Headache. Nausea/vomiting. Decreased consciousness. Papilledema (later)
  • Severe Cases: Coma. Brainstem signs. Respiratory abnormalities

Examination

  • Neurological Examination: Level of consciousness. Cranial nerve deficits. Motor and sensory deficits. Pathological reflexes (Babinski sign)
  • Fundoscopy: Possible hypertensive retinopathy. Papilledema

Diagnosis

CT Brain (First-line Investigation): Hyperdense (bright) hemorrhage. Identifies size and location. Detects ventricular extension

MRI: Useful in selected cases and chronic stages

Additional Tests: CT angiography (suspected AVM/aneurysm). Coagulation studies

Differential Diagnosis: Ischemic stroke. Subarachnoid hemorrhage. Brain tumor with bleeding. Brain abscess. Traumatic intracranial hemorrhage

Treatment

Acute Management: ICU/stroke unit monitoring. Blood pressure control. Management of cerebral edema. Correction of coagulopathy

Surgical Treatment

Indicated in selected patients: Cerebellar hemorrhage. Large hematomas with mass effect. Hydrocephalus

Complications: Brain herniation. Intraventricular hemorrhage. Hydrocephalus. Seizures. Death

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