Central nervous system disorders

I./4.1.: Epidemiology

Intracerebral hemorrhage account for 15-20% of all cerebrovascular diseases in Caucasians. Prevalence is higher in Afro-Americans and in Asian countries because of higher frequency of hypertension. Incidence of cerebral hemorrhage increases by age: 2/100 000/year below 40-year old and 350/100 000/year above 80-years old. Mortality is very high: 35-50%.

I./4.2.: Presentation

In most intracerebral hemorrhages, the ictal initial symptoms progress over minutes or hours (average period of growth is around 6 hours by CT monitoring). Focal symptoms may be associated with worsening headache, increased intracranial pressure, and global cerebral dysfunction - primarily hypnoid unconsciousness- depending on size of the bleeding. Clinical progression remains unwitnessed on several occasions. Growth of the hemorrhage stopped by pressure of the surrounding tissue and/or increased intracranial pressure. If the hematoma reaches the lower pressure ventricles, could spread into them (intraventricular propagation).

Clinical deterioration observed on the second-third postictal day is a result of the growing perifocal oedema not the hemorrhage enlargement.