UMEM Educational Pearls


68 year-old male presents with 3-4 days of hedache, anorexia for 2 weeks and "balance trouble." His blood pressure was 226/140 and he states he has not been on his medications for 6 months.
Physical examination revealed a shuffled gait with his walker and the rest of his physical exam and neurologic exam was unremarkable. 
His CT is seen below. What's the diagnosis?


Answer: Large left cerebellar intraparenchymal hemorrhage with surrounding vasogenic edema with mild infratentorial midline shift of ~4mm


Take Home Points:

  • Ambulate every patient when doing a neurologic exam (as they can tolerate)
  • Reverse anticoagulation, if necessary
  • BP control in intracerebral hemorrhage
    • Still exist different opinions with BP thresholds
    • 2015 AHA/ASA guidelines: reduction of SBP to 140 is safe
    • Refer to a previous pearl for more information


Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032-60.