Abstract (EN):
Spontaneous intracerebral hemorrhages (ICH) account for 10–30% of all strokes and are a result of acute bleeding into the brain due to ruptures of small penetrating arteries. Despite major advancements in the management of ischemic strokes and other causes of hemorrhagic strokes, such as ruptured aneurysm, arteriovenous malformations (AVMs), or cavernous angioma, during the past several decades, limited progress has been made in the treatment of ICH, and the prognosis for patients who suffer them remains poor. The societal impact of these hemorrhagic strokes is magnified by the fact that affected patients typically are a decade younger than those afflicted with ischemic strokes. The ICH continues to kill or disable most of their victims. Some studies show that those who suffer ICH have a 30-day mortality rate of 35–44% and a 6-month mortality rate approaching 50%. Approximately 700,000 new strokes occur in the United States annually and approximately 15% are hem-orrhagic strokes related to ICH. The poor outcome associated with ICH is related to the extent of brain damage. ICH produces direct destruction and compression of surrounding brain tissue. Direct compression causes poor perfusion and venous drainage to surrounding penumbra at risk, resulting in ischemia to the tissues that most need perfusion [16].
Diagnosis of ICH is based largely on clinical history and corroborative Computer Tomography (CT) scanning of the brain. The head CT scan has a sensitivity and specificity that approach 100% for acute ICH. The hemorrhage volume is the most important predictor of clinical outcome after ICH [20]. The volume of ICH can be estimated rapidly with a head CT. It is an important prognostic indicator and criterion for therapeutic intervention and its expansion can be associated with neurological deterioration. Contrast-enhanced CT scan and newer CT angiographic (CTA) acquisitions can now be performed quickly with the latest-generation scanners. These images can exclude most gross vascular and tumor causes of hemorrhage rapidly and can have an impact on the therapeutic plan [16].
Language:
Portuguese
Type (Professor's evaluation):
Scientific