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Though much faster than chronic subdural bleeds, acute subdural bleeding is usually venous and therefore slower than the arterial bleeding of an epidural hemorrhage. Acute subdural hematomas due to trauma are the most lethal of all head injuries and have a high mortality rate if they are not rapidly treated with surgical decompression. [23]
Hypertension (high blood pressure) Diabetes mellitus; Menopause; Excessive alcohol consumption; Severe migraine; Hypertension is the strongest risk factor associated with intracerebral hemorrhage and long term control of elevated blood pressure has been shown to reduce the incidence of hemorrhage. [7]
Documented goals for blood pressure include a reduction in the mean arterial pressure by less than or equal to 25% within the first 8 hours of emergency. [7] If blood pressure is lowered aggressively, patients are at increased risk of complications including stroke, blindness, or kidney failure. [ 6 ]
Subdural hemorrhage (SDH) results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater. It can cross the suture lines, but not across dural reflections such as falx cerebri or tentorium cerebelli. [4] Therefore, subdural hematoma always limited to one side of the brain. [3]
Guidelines on the choice of agents and how best to step up treatment for various subgroups in hypertension (high blood pressure) have changed over time and differ between countries. A Comparison of International Guidelines on Goal Blood Pressure and Initial Therapy for Adults With Hypertension (adapted from JNC 8 guidelines [ 1 ] )
Secondly, high blood pressure is a silent disease and thus it is vital for all diabetics to regularly check their blood pressure or have it checked at a doctor's office on a regular basis. The American Diabetes Association recommends that all diabetics get their blood pressure measured by a health care professional at least 2-5 times a year. [94]
Cerebral amyloid angiopathy may cause intraparenchymal hemorrhage even in patients without elevated blood pressure. Unlike hypertension, cerebral amyloid angiopathy does not typically affect blood vessels to deep brain structures. Instead, it is most commonly associated with hemorrhage of small vessels in the cerebral cortex. [2]
There are no universally accepted blood pressure lowering goals in those with PRES and hypertension, however, if there is a hypertensive emergency, the blood pressure may lowered quickly, but not less than 25% within the first hour with the goal of blood pressure normalization within 24 to 48 hours. [2]