Neurology Exam Prep Podcast Episode 27 - Intracranial Hemorrhage
Jan 2, 2021
In this insightful discussion, Dr. Jennifer Kim, a neurocritical care attending, shares her expertise on intracranial hemorrhage, particularly intracerebral hemorrhage. She delves into the nuances of hypertensive hemorrhages and their imaging characteristics, the impact of vascular malformations like AVMs and aneurysms, and the role of anticoagulation in increasing hemorrhagic risk. Key topics include the management of ICH and surgical interventions, alongside prognostic scoring and critical care strategies. A must-listen for neurology residents!
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CAA Shows Cortical Lobar Bleeding
- Cerebral amyloid angiopathy causes lobar, cortical hemorrhages and cortical microbleeds visible on SWI sequences.
- Superficial siderosis on imaging is another CAA clue and may correlate with seizures or cortical symptoms.
Suspect Tumor With Gray–White Junction Bleed
- Hemorrhagic metastases often localize to the gray–white junction and provoke disproportionate vasogenic edema.
- Repeat contrast MRI after blood clears (2–3 months) can reveal underlying tumor missed acutely.
Act On The CTA 'Spot Sign'
- On CTA look for the 'spot sign'—contrast extravasation inside the hematoma—to identify active bleeding.
- If present, intensify blood pressure control and reverse anticoagulation urgently.