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Hypertensive intracranial hemorrhage is defined as acute nontraumatic hemorrhage secondary to systemic hypertension, and is the most common cause of intracranial hemorrhage in the adult population. About 50% of nontraumatic intracranial hemorrhages are attributed to hypertension. Patients with hypertensive hemorrhage often have a history of long-standing and poorly controlled hypertension, which is hypothesized to lead to atherosclerosis and fibrinoid necrosis of the intracranial vessels. The vessels that are most commonly affected are perforating small vessels. Microaneurysms of these perforating arteries, termed Charcot -Bouchard aneurysms, are thought to be responsible for the hemorrhages. The small penetrating vessels involved are predominately found in the lenticulostriate regions, with a small percentage also found in the pons and cerebellum. As a result, these locations represent the most common sites of hypertensive hemorrhage, with the basal ganglia and thalami being the most commonly involved (80%), followed by the pons and cerebellum (10%). Approximately 5% to 10% of patients will have a lobar hemorrhage.Hypertensive intracranial hemorrhage most commonly occurs in the middle-aged to elderly patients and in males. African Americans are affected more frequently, which likely reflects the high prevalence of hypertension in this population. About 20% of patients presenting with acute neurologic deficits have hypertensive intracranial hemorrhage, and large hypertensive hemorrhages may lead to impaired consciousness and sensorimotor deficits as was the case in the presented patient. The imaging findings in this case are typical for hypertensive hemorrhage in the basal ganglia. The large left to right midline shift and compression of the bilateral lateral ventricles are mass effect complications that may result from a large hematoma. Intraventricular extension of the hematoma with associated hydrocephalus can occur and portends a poor prognosis. Treatment of hypertensive intracranial hemorrhage is mostly nonsurgical. Evacuation of the hematoma itself has no associated benefit in most cases. Symptomatic management of the mass effect and decreasing intracranial pressure by medical management and ventricular shunting is the mainstay of treatment. Notes： 1. atherosclerosis /ˌæθərəʊsklɪə'rəʊsɪs/ /ˌæθərosklɪ'rosɪs/ n. 动脉粥样硬化 2. fibrinoid necrosis /'faɪbrə,nɔɪd/ /ˈfaɪbrəˌnɔɪd/ 纤维素样坏死 3. lenticulostriate regions 豆纹动脉支配的区域 4. consciousness /'kɒnʃəsnɪs/ /'kɑnʃəsnəs/ n. 知觉，意识 5. hydrocephalus /ˌhaɪdrə'sef(ə)ləs/ /'haɪdrə'sɛfələs/ n. 脑积水 6. evacuation /ɪ,vækjʊ'eɪʃ(ə)n/ /ɪ,vækjʊ'eʃən/ 清除、排泄 |
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DISCUSSION
