Intracerebral Hemorrhage

A 60-year-old female presented to the emergency department in a state of unconsciousness. She was found unconscious on the floor of her bedroom by her daughter in the morning. She had gone to bed at 9 pm the day before and was in a state of good health. She had hypertension for the previous 20 years and was on irregular medications. In the emergency department, she had a Glasgow Coma Scale (GCS) of E3V aphasia and M5 (GCS 8/10) and had weakness of the right half of the body. She had blood pressure of 220/100 mmHg, pulse of 60/min and regular breathing. Bilateral pupils were round, regular and reactive to light. She was started on injection labetalol and after her blood pressure stabilised was sent for computed tomography (CT) of the head with suspicion of stroke. CT of the head revealed a large intracerebral hematoma in the left putamen with an approximate volume of 24 mL with effacement of the sulci and lateral ventricle (Fig. 12.1). She was then managed in the ICU with regular BP monitoring with invasive arterial blood pressure monitoring and hourly monitoring of GCS. She was not on any anticoagulants and her coagulation profile was normal. She had an uneventful recovery, but with residual weakness of the right half of the body.