0:01

Another patient presenting with worse

0:03

headache of life and elevated blood pressure.

0:06

Now, it's true that when you have subarachnoid

0:09

hemorrhage, the presence of the hemorrhage in the

0:13

brain and the anxiety associated with the severe

0:16

pain can lead to elevation of the blood pressure.

0:19

And then we say, well, is it primarily hypertension,

0:22

secondary to the subarachnoid hemorrhage, or

0:26

did the patient have hypertension in advance?

0:29

And, you know, often the patient has

0:30

a clinical history of hypertension.

0:32

This patient had a clinical history of hypertension.

0:35

And once again, what we see is a parenchymal

0:38

hemorrhage that is associated with perforation into the

0:42

ventricular system with intraventricular hemorrhage,

0:47

in the absence of basal cistern subarachnoid hemorrhage.

0:52

And therefore, one should suggest that this

0:55

represents a primary hypertensive bleed with

1:00

perforation into the ventricular system.

1:03

If you have isolated hemorrhage in the ventricle,

1:08

with no other findings, the things we think

1:11

about are, number one, trauma with splenium tear

1:17

and collection of blood in the occipital

1:19

horns of the lateral ventricles.

1:21

Number two, hypertensive bleed with a small

1:24

parenchymal component that bleeds into and

1:27

perforates into the ventricular system.

1:30

And number three is arteriovenous malformation,

1:34

in the absence of subarachnoid hemorrhage,

1:37

and isolated intraventricular hemorrhage.

1:39

Arteriovenous malformations are a

1:42

more common source than aneurysm.

1:45

Aneurysms, because they float in the

1:47

subarachnoid space around the circle of Willis,

1:50

are going to cause subarachnoid hemorrhage.

1:53

In the absence of subarachnoid hemorrhage and

1:55

isolated intraventricular hemorrhage, arteriovenous

2:00

malformations are a more common source than aneurysms.

2:04

So in this situation, again, we would say hypertension,

2:08

with intraventricular hemorrhage, no need for a CTA.

2:12

This is a hypertensive bleed.

2:15

And nonetheless, you'll find that

2:19

the clinicians will order a CTA.

2:22

Sometimes the CTA will show an

2:23

incidental aneurysm that is unrelated

2:26

to the bleeding.

2:27

So if you find an intercommunicating artery

2:30

aneurysm in this patient, it's not going

2:32

to be the source of this thalamic bleed.

2:35

But it will be an aneurysm that

2:37

potentially needs treating at some

2:39

point, depending upon the patient's age.

Case: Hypertensive Bleed, IPH with IVH on CT (Case 2)

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