Intracerebral hemorrhage (mechanism of disease)

This is a flowchart on intracerebral hemorrhage, covering the etiology, pathophysiology, and manifestations.
ADDITIONAL TAGS:
Bleed into …
Putamin (~56%)
Neoplasms (meningioma)
Risk factors / SDOH
Cell / tissue damage
Structural factors
Intracerebral hemorrhage
Medicine / drugs
Infectious / microbial
Biochem / molecular bio
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Metabolic / hormonal
Genetics / hereditary
Flow physiology
Pathophysiology
Etiology
Manifestations
Intracerebral hemorrhage: bleeding into the brain parynchema
Blunt or penetrating injury
Chronic arterial hypertension
Traumatic
Nontraumatic
Damage to vessels
Formation and rupture of Charcot-Bouchard microaneurysms → bleed into putamen thalamus pons, cerebellum
Cerebral amyloid angiopathy
Deposition of β-amyloid peptides in vessel walls
Focal damage with formation of micro- aneurysms → rupture
Structural abnormalities like vascular malformations
Some vasculature gets excessive strain → rupture
Coagulopathy (hemophilia, anticoagulants)
Impaired hemostasis
Accumulation of vascular microtrauma
Inflammatory tissue necrosis → damages vessels
Infections (HSV encephalitis)
Ischemia → reperfusion injury
Acute arterial hypertension
Venous outflow obstruction
Stimulants (cocaine, meth)
Vasculitis (giant cell arteritis)
Infective endocarditis → septic emboli
Blood irritates meninges
Meningeal traction
↑ intracranial pressure
Headache
Nausea, vomiting
Confusion
Fixed pupils
Bradycardia
Loss of consciousness
Thalamus (~31%)
Contralateral hemiparesis or hemiplegia
Contralateral hemisensory loss
Eyes deviate towards side of hematoma
“Wrong way eyes”
Hemorrhage extends into ventricles
Hydrocephalus
Brain herniation
Widened pulse pressure
Irregular breathing
Cushing triad
Symptoms progress gradually over minutes to hours