see also:

• stroke (CVA)
• subarachnoid haemorrhage (SAH)
• intracerebral haemorrhage (ICH) in adults

• non-traumatic bleeding into the intracranial ventricles in adults is generally the result of either:
  • subarachnoid haemorrhage (SAH)
  • extension of intracerebral haemorrhage (usually in the thalamic ganglionic region) which is generally caused by:
    • chronic hypertension causing development of Charcot-Bouchard aneurysms and thus incidence of ICH doubles for each decade over 50yrs age until 80yrs in those with HT
    • hypertensive crisis
    • eclampsia
    • drug abuse
    • autoregulatory dysfunction of cerebral blood flow (especially if thrombolytics used):
      • reperfusion injury
      • haemorrhagic transformation of ischaemic stroke
      • cold exposure
    • altered clotting system:
      • thrombolysis
      • anticoagulation including snakebite and envenomation
      • bleeding diasthesis
    • arteriopathy
    • haemorrhagic necrosis (neoplasm, infection)
    • cerebral venous thrombosis raising intracerebral vascular pressures
  • bleeding from subependymal structures:
    • germinal matrix (mainly neonates)
    • AV malformation
    • cavernous angioma

• onset usually during daytime activities and progressive development over minutes to hours of:
• acute onset headache in 40%
• vomiting in 40-50%
• decreased mental state in 50%
• seizures in < 10%
• +/- focal neurology
  • NB. prodromal focal neurology may occur in lobar ICH associated with cerebral amyloid angiopathy

• most require Mx in a resuscitation room if deemed Mx is not futile
• iv access, bloods for FBE, U&E, clotting profile
• nurse at 30deg head up
• ABC's and consider early intubation if GCS is < 8
• CT brain to confirm bleed
• urgently reverse coagulopathy if possible
• liaise with neurosurgery