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0:00
Hello everybody.
My name is Stefanie Schreiber.
I'm a professor for neurology
at Otto-von-Guericke University
in Magdeburg, Germany.
It's my pleasure to tell you
about no-clear-cause
intra-cerebral hemorrhage
to give an overview of subtypes,
causes, and mechanisms.
0:21
First of all,
I will show you the
subtypes of locations
of spontaneous
intra-cerebral hemorrhages.
In the upper row, you
see lobar hemorrhages
next to deep hemorrhages,
cerebellar hemorrhages
and primary intraventricular
hemorrhages.
Here I show you an analysis
from our own clinic,
where we have looked at the
frequency of the location
of different intracerebral
hemorrhages.
You can see that
lobar hemorrhages
are the most frequent ones,
followed by deep hemorrhages,
cerebellar and primary
intraventricular hemorrhages.
The study was conducted
in 922 patients
with spontaneous
intra-cerebral hemorrhage
and who came from the
Magdeburg cohort.
You see the lobar hemorrhages
were most common in
the frontal lobe,
followed by the temporal,
parietal, and occipital lobe.
The deep hemorrhages
were most frequent in
the basal ganglia,
followed by mixed locations
between basal
ganglia and thalamus
and less frequent
in the brain stem.
1:28
Next, I will show you how
to classify the subtypes
of spontaneous
intra-cerebral hemorrhage
according to the
CHARTS instrument.
This is a scale or a
kind of questionnaire
where radiologists
are asked to localize
the lobar and deep and
infratentorial hemorrhages
according to the sub-regions.
Lobar hemorrhages are classified
as frontal, parietal, temporal,
occipital or insular,
as you can see on figure A,
and the classification
is taking place
according to the
epicenter of the ICH.
Often the ICH is distributed
across different lobes,
but you choose the localization
according to the lobe where
the epicenter is placed.
For example,
you see on the right upper
row the frontal hemorrhage.
On the B subfigure you see
the classification or
the categorization
of the deep intra-cerebral
hemorrhages,
again according
to the epicenter,
and they could be placed
in basal ganglia,
subdivided into
lentiform hemorrhages
or caudate hemorrhages,
where you see examples
in mid of the upper row
or in the left corner
of the lower row.
Then there's a division
into thalamic hemorrhages
where you can see an example
on the mid of the lower row.
Brainstem hemorrhages and
cerebellar hemorrhages
are part of the
infratentorial hemorrhages.
There's another category
in CHARTS that are
the uncertain
localized hemorrhages,
which are divided into probable
lobar or probable deep.
Uncertain means that
the hemorrhage cannot
really focus on a primary lobar
or on a primary
deep localization
but could extend to
lobar and deep regions.
You see an example in figure B
on the right lower sub figure,
we see a holohemispheric,
which is also a large hemorrhage
which covers lobar and
deep brain regions.
But as the epicenter
is in deep areas,
we can classify this as a deep
intra-cerebral hemorrhage.
