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* intracerebral hemorhage is progressive
 #133400  
  3stepstomle - 10/29/06 01:14
 
  * Onset of symptoms of ICH is usually during daytime activity, with progressive (ie, minutes to hours) development of the following:

o Alteration in level of consciousness (approximately 50%)

o Nausea and vomiting (approximately 40-50%)

o Headache (approximately 40%)

o Seizures (approximately 6-7%)

o Focal neurological deficits

* Lobar hemorrhage due to cerebral amyloid angiopathy may be preceded by prodromal symptoms of focal numbness, tingling, or weakness.

* A history of hypertension, trauma, illicit drug abuse, or a bleeding diathesis may be elicited.

Physical: Clinical manifestations of ICH are determined by the size and location of hemorrhage, but may include the following:

* Hypertension, fever, or cardiac arrhythmias

* Nuchal rigidity

* Subhyaloid retinal hemorrhages

* Altered level of consciousness

* Anisocoria

* Focal neurological deficits

o Putamen - Contralateral hemiparesis, contralateral sensory loss, contralateral conjugate gaze paresis, homonymous hemianopia, aphasia, neglect, or apraxia

o Thalamus - Contralateral sensory loss, contralateral hemiparesis, gaze paresis, homonymous hemianopia, miosis, aphasia, or confusion

o Lobar - Contralateral hemiparesis or sensory loss, contralateral conjugate gaze paresis, homonymous hemianopia, abulia, aphasia, neglect, or apraxia

o Caudate nucleus - Contralateral hemiparesis, contralateral conjugate gaze paresis, or confusion

o Brain stem - Quadriparesis, facial weakness, decreased level of consciousness, gaze paresis, ocular bobbing, miosis, or autonomic instability

o Cerebellum - Ataxia, usually beginning in the trunk, ipsilateral facial weakness, ipsilateral sensory loss, gaze paresis, skew deviation, miosis, or decreased level of consciousness

Causes:
 
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