Cerebral hemorrhage: eccentric pearls to know for boards

1. Fifty percent of hemorrages are putamenal. In order of frequency, then are lobar, thalamic, cerebellar and pontine hemorrhages.
2. Hematocrit effect refers to fluid fluid level due to red cells settling and is particularly prone to occur in anticoagulant associated hemorrhages.
3. Color wise, as oxyhemoglobin is liberated and becomes deoxygenated, methemoglonin is formed and is brown. With phagocytosis, color changes from dark red to pale red to golden brown of hemosiderin stain.
4. Hypertensive hemorrhage classically is due to segmental lipohyalinosis and false aneurysm (microaneurysm) of Charcot-Bouchard (CMF found absent CB aneurysms in some studied cases)
5. The presentation of putamenal hemorrhage is usually HA, vomiting, and hemiplegia that worsens.
6. The frequency of lobar hemorrhages in order is occipital, temporal, frontal and parietal.
7. Cerebellar hematomas are most dangerous if more than 4 mm ind located in vermis. 2mm or less is managed medically. 2-4 mm is a typical conundrum.
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