Intracerebral Hemorrhage

Intracerebral Hemorrhage

An intracerebral hemorrhage is bleeding within the brain.

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Intracerebral hemorrhage usually results from chronic high blood pressure.
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The first symptom is often a severe headache.
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Diagnosis is based on symptoms and results of a physical examination and imaging tests.
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Treatment may include vitamin K, transfusions, and, rarely, surgery to remove the accumulated blood.

Intracerebral hemorrhage accounts for about 10% of all strokes but for a much higher percentage of deaths due to stroke. Among people older than 60, intracerebral hemorrhage is more common than subarachnoid hemorrhage.

Causes

Intracerebral hemorrhage most often results when chronic high blood pressure weakens a small artery, causing it to burst. Using cocaine or amphetamines can cause temporary but very high blood pressure and hemorrhage. In some older people, an abnormal protein called amyloid accumulates in arteries of the brain. This accumulation (called amyloid angiopathy) weakens the arteries and can cause hemorrhage.

Less common causes include blood vessel abnormalities present at birth, injuries, tumors, inflammation of blood vessels (vasculitis), bleeding disorders, and use of anticoagulants in doses that are too high. Bleeding disorders and use of anticoagulants increase the risk of dying from an intracerebral hemorrhage.

Symptoms

An intracerebral hemorrhage begins abruptly. In about half of the people, it begins with a severe headache, often during activity. However, in older people, the headache may be mild or absent. Symptoms suggesting brain dysfunction develop and steadily worsen as the hemorrhage expands. Some symptoms, such as weakness, paralysis, loss of sensation, and numbness, often affect only one side of the body. People may be unable to speak or become confused. Vision may be impaired or lost. The eyes may point in different directions or become paralyzed. The pupils may become abnormally large or small. Nausea, vomiting, seizures, and loss of consciousness are common and may occur within seconds to minutes.

Diagnosis

Doctors can often diagnose intracerebral hemorrhages on the basis of symptoms and results of a physical examination. However, computed tomography (CT) or magnetic resonance imaging (MRI) is also done. Both tests can help doctors distinguish a hemorrhagic stroke from an ischemic stroke. The tests can also show how much brain tissue has been damaged and whether pressure is increased in other areas of the brain. The blood sugar level is measured because a low blood sugar level can cause symptoms similar to those of stroke.

Prognosis

Intracerebral hemorrhage is more likely to be fatal than ischemic stroke. The hemorrhage is usually large and catastrophic, especially in people who have chronic high blood pressure. More than half of the people who have a large hemorrhage die within a few days. Those who survive usually recover consciousness and some brain function over time. However, most do not recover all lost brain function.

Treatment

Treatment of intracerebral hemorrhage differs from that of an ischemic stroke. Anticoagulants (such as heparin and warfarin Some Trade Names
COUMADIN
), thrombolytic drugs, and antiplatelet drugs (such as aspirin Some Trade Names
BAYER
) are not given because they make bleeding worse. If people who are taking an anticoagulant have a hemorrhagic stroke, they may need a treatment that helps blood clot such as

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Vitamin K, usually given intravenously
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Transfusions of platelets
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Transfusions of blood that has had blood cells and platelets removed (fresh frozen plasma)
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Intravenous administration of a synthetic product similar to the proteins in blood that help blood to clot (clotting factors)

Surgery to remove the accumulated blood and relieve pressure within the skull, even if it may be life-saving, is rarely done because the operation itself can damage the brain. Also, removing the accumulated blood can trigger more bleeding, further damaging the brain and leading to severe disability. However, this operation may be effective for hemorrhage in the pituitary gland or in the cerebellum. In such cases, a good recovery is possible.