Fluid-blood levels in Intracranial Hemorrhage

Excerpt from the Stroke Article
ref: http://stroke.ahajournals.org/content/24/4/554.full.pdf

"The cause of lobar hemorrhage after fibrinolytic treatment remains puzzling. We speculate, but have
proof in only one patient, that the presence of amyloid angiopathy may be an important risk factor. We cannot exclude the possibility, however, of hemorrhage into a prior silent infarction as the mechanism in some of these patients. Long-standing hypertension has been specifically implicated as a risk factor for cerebral
hemorrhage.
However, the site of hemorrhage associated with hypertension is usually in the distribution of perforating vessels, not lobar.
Patients with hypertension alone usually have bleeding into sites such as basal ganglionic, posterior lateral thalamus, pons, and cerebellar hemispheres.
Patients with hypertension and lobar hemorrhages may have amyloid angiopathy as well.

One recent study of surgically treated patients with lobar hematomas indeed suggested that amyloid angiopathy is a major contributing factor. 

In two series of patients with lobar hemorrhage but without anticoagulant or fibrinolytic treatment, hypertension was found in only one third of the patients. Although hemorrhage into the cerebellum has traditionally been linked to hypertension, blood pressure was normal in our one patient with a massive vermis hemorrhage. Furthermore, one study claimed that vermis hemorrhages were relatively frequent in anticoagulated patients."

" We suspect, therefore, that cerebral amyloid angiopathy may be a contributing, if not crucial, factor in

fibrinolysis-associated hemorrhages. Intracerebral lobar hemorrhage is frequently associated with cerebral amyloid angiopathy in patients in the sixth or seventh decade of life. It encompasses multiple, usually superficially located, areas of hemorrhage on CT scans. Frontal or parietal lobe hemorrhages are common, but cerebellar and putaminal locations have been described in association with amyloid angiopathy. Recently, it was also noted that cerebral amyloid angiopathy associated with lobar intracerebral hemorrhage resulted in good outcome in the vast majority of patients."