Pathophysiology

In 80% of patients, the hypertensive ICH is located in the region of the basal ganglia; in the remainder of cases, the hemorrhage occurs in the hindbrain, in either the pons or cerebellum. As the hemorrhage is arterial, it enlarges rapidly, causes considerable destruction of the brain, and can result in herniation and death within the first 24 - 48 hr after initial hemorrhage. The hematoma can also rupture into the ventricles, resulting in acute hydrocephalus, which further aggravates the raised intracranial pressure (ICP). After the initial hemorrhage, natural history studies have demonstrated that continued expansion of the hematoma is common (7,8).

Table 1 Etiologic Factors for Intracerebral Hemorrhage

Primary

Acute and chronic hypertension

Secondary

Structural

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