Intraparenchymal (IPH) & Intraventricular (IVH) Hemorrhage
1. Intraparenchymal Hemorrhage (IPH)
- Primary Cause: Chronic hypertension is the #1 cause. Common sites: Putamen (most common), Thalamus, Pons, Cerebellum.
- Secondary Causes (Consider if non-hypertensive location/patient): Cerebral Amyloid Angiopathy (lobar hemorrhage in elderly), coagulopathy, tumor, or vascular malformation (AVM).
- Radiology: Hyperdense (bright) mass on NCCT with surrounding hypodense vasogenic edema.
2. Intraventricular Hemorrhage (IVH)
- Classification:
- Primary: Originating within the ventricles (rare, e.g., choroid plexus tumor, vascular malformation).
- Secondary: Extension of IPH or SAH into the ventricular system (much more common).
- Radiology: Hyperdensity within the lateral, third, or fourth ventricles, often displaying a “fluid-blood level” (dependent layering of blood).
3. Clinical Pearls & Management
| Key Concept | High-Yield Note |
|---|---|
| Acute Hydrocephalus | IVH can obstruct CSF outflow (e.g., at the Foramen of Monro or Aqueduct of Sylvius), requiring emergency EVD (External Ventricular Drain). |
| BP Management | Tight control (e.g., target SBP < 140 mmHg) is critical in IPH to limit hematoma expansion. |
4. Warning Signs
Cerebellar Hemorrhage: A surgical emergency. Can cause rapid brainstem compression and hydrocephalus due to proximity to the 4th ventricle.