Intracerebral hemorrhage physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Physical examination

Physical examination

Physical examination of patients with Intracerebral hemorrhage is usually varies based on the location of the bleeding.

Thalamic haemorrhage

downward gaze (paralysis of upward gaze) small pupils (lack of light pupillary response) depressed consciousness apathy hypersomnolence disorientation visual hallucinations aphasia impairment of verbal memory visuospatial dysfunction

  • Thalamic strokes can also present with behavioural patterns depending on the four main arterial thalamic territories:
    • anterior: perservations, apathy and amnesia
      • paramedian infarction: disinhibition, personality change and amnesia (severe retrograde and anterograde amnesia)
      • extensive lesions: "thalamic dementia"
    • inferolateral: executive dysfunction and occasionally severe long term disability
    • posterior: no specific behavioural pattern however can include cognitive dysfunction, neglect, aphasia

35 percent of cases, subcortex in 30 percent, cerebellum in 16 percent, thalamus in 15 percent, and pons in 5 to 12 percent

Locations Physical examination
Putamenal hemorrhage (35%)
Thalamic hemorrhage (15%) General signs:
Behavioural patterns based on the four main arterial thalamic territories:
Pontine hemorrhage (5-12%)
  • Decreased level of consciousness (most common)
  • Long tract signs including tetra paresis
  • Cranial nerve palsies
  • Seizures
  • Cheyne-Stokes respiration
Cerebellar hemorrhage (16%)
Lobar hemorrhage
  • Acute neurological deterioration
  • Decreased GCS

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