History
Onset of symptoms is generally abrupt.
Presentation varies greatly, depending on the size and location of the hemorrhage. Some patients are alert with headache and perhaps vomiting; others may be unresponsive with impaired or absent brainstem reflexes.
The following symptoms are roughly in descending order of incidence:
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Headache of abrupt onset
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Nausea and vomiting
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Inability to walk (reflecting truncal ataxia)
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Dizziness, vertigo
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Dysarthria
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Nuchal pain
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Loss or alteration of consciousness
Physical
Physical examination findings also are variable. Some patients are alert and cooperative, while others are in a coma.
Signs generally are of abrupt onset and may change suddenly with progressive expansion of hematoma.
Signs tend to cluster with level of consciousness.
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Diminished level of consciousness (uncooperative to comatose)
Irregular respirations
Extensor plantar responses
Impaired oculocephalic responses and a variety of other abnormal eye movements
Decreased or absent corneal responses
Impaired or absent pupillary responses
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Lateralizing cerebellar signs may be present in a patient who is alert enough to cooperate with examination.
Limb ataxia
Dysarthria
Possible presence of extensor plantar responses (unilateral or bilateral)
Nuchal rigidity
Nystagmus
Gaze palsy (ipsilateral to hematoma)
Facial weakness
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Gait difficulty in patients able to cooperate is a nonspecific finding.
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Noncardiac or neurogenic cardiopulmonary complications may include findings of pulmonary edema, hypertension, bradycardia, and arrhythmia. [5]
Causes
Causes are similar to those of other types of intracranial hemorrhage. Approximately two thirds of CHs are believed to be hypertensive hemorrhages.
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Hypertension - Suspected rupture of small penetrating vessels
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Anticoagulant use
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Blood dyscrasias
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Aneurysm/arteriovenous malformation rupture
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Sympathomimetic drug use
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Hemorrhage into tumor
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Dural leak or large CSF removal associated with supratentorial surgery, spinal surgery, or spontaneous intracranial hypotension.
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CADASIL [1]
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Large hemorrhage of cerebellar vermis.
