What Is Intracerebral Hemorrhage?

Overview

An illness known as intracerebral hemorrhage (ICH) is characterized by bleeding inside the actual brain tissue. It happens whenever a blood artery bursts, allowing blood to flow into the nearby brain tissues.This condition is a subtype of stroke (15-30% of strokes) and is considered a medical emergency. 

Early diagnosis, appropriate treatment, and comprehensive rehabilitation play key roles in managing this condition and optimizing the chances of recovery.¹

Causes of intracerebral hemorrhage

• Hypertension (high blood pressure): Uncontrolled hypertension damages the lining of blood vessels, making them more prone to rupture and causing intracerebral stroke
• Trauma injury: Severe head injuries leads to intracerebral stroke by causing blood vessels within the brain to rupture and bleed
• Vascular abnormalities: Conditions such as arteriovenous malformations (AVMs) or cerebral aneurysms can raise potential hazards of intracerebral stroke. AVMs are abnormal tangles of blood vessels, while aneurysms are weakened areas that can balloon out and rupture
• Blood disorders: Certain blood disorders, including hemophilia or clotting disorders, can increase the risk of spontaneous bleeding causing intracerebral stroke
• Medications: Certain medications, such as anticoagulants or antiplatelet drugs, can raise the risk of bleeding and potentially lead to intracerebral stroke
• Illicit drug use: Illicit drugs like cocaine or amphetamines can increase blood pressure and contribute to the risk of intracerebral stroke
• Cerebral amyloid angiopathy (CAA): CAA involves the deposition of amyloid protein in the brain's blood vessels, compromising the vessel's walls and elevating the possibility of bleeding
• Liver disease: Conditions like cirrhosis or liver failure can disrupt the body's clotting mechanism, making it easier for intracerebral stroke to occur
• Bleeding disorders: Inherited bleeding disorders, including hemophilia or von Willebrand disease, can increase the risk of intracerebral stroke
• Atherosclerosis: Atherosclerosis refers to the buildup of plaque in the blood vessels, narrowing them and making them more susceptible to rupture and causing intracerebral stroke

It's important to seek medical attention for proper evaluation and management of these underlying causes to minimize the risk of intracerebral stroke.

Signs and symptoms of intracerebral hemorrhage

• Sudden and severe headache
• Loss of consciousness
• Weakness or paralysis on one side of the body
• Changes in vision, such as blurred or double vision
• Speech or communication disability
• Nausea or vomiting
• Dizziness or loss of balance
• Seizures
• Cognitive changes or confusion
• Stiff neck or neck pain (in some cases)

These symptoms may vary depending on the location and extent of the bleeding within the brain. If someone experiences these symptoms, it is crucial to seek immediate medical attention as intracerebral hemorrhage is a medical emergency.

Management and treatment for intracerebral hemorrhage

• Prompt medical attention and hospitalization for close monitoring and assessment
• Stabilization of vital signs, ensuring proper oxygenation, blood pressure control, and management of any underlying medical conditions
• Imaging tests, such as CT scans or MRIs, to diagnose and assess the extent of the hemorrhage
• Surgical intervention, such as craniotomy or minimally invasive procedures, to remove the blood clot and relieve pressure on the brain, if aBlood tests, including coagulation studies, may be performed to evaluate the patient's blood clotting function and rule out any underlying bleeding disorders propriate
• Medications to control blood pressure, manage symptoms, and prevent further complications
• Close monitoring of neurological status and vital signs to detect any changes or complications
• Rehabilitation therapies, including physical therapy, occupational therapy, and speech therapy, to aid in recovery and regain lost functions
• Supportive care, including pain management, prevention of infections, and maintaining a conducive environment for healing
• Ongoing follow-up care to monitor progress, adjust medications, and address any long-term complications or rehabilitation needs

Diagnosis

For the diagnostic purpose of stroke CT scan of brain is recommended as initial treatment done to identify and locate the bledding. When the patient is stabilized, MRI is suggested for more accurate diagnosis. Blood tests that include coagulation studies, done to evaluate the patient's clotting profile. A test named spinal tap is performed as lumber puncture to identify any infection in CSF or bleeding. 

Complications

Certain complications and their severity depends on factors such as its location, size, underlying cause of the intracerebral hemorrhage,and overall  individual's health.

• Brain edema: Intracerebral hemorrhage can lead to swelling (edema) in the brain tissue surrounding the bleeding site. Brain edema can increase pressure within the skull and potentially cause further damage to brain structures
• Increased intracranial pressure: Accumulation of blood within the brain can elevate intracranial pressure, leading to symptoms such as severe headaches, nausea, vomiting, altered mental status, and potentially herniation of brain tissue
• Neurological deficits: Depending on the location and extent of the bleeding, intracerebral hemorrhage can result in neurological deficits such as weakness or paralysis on one side of the body, vision changes, speech difficulties, cognitive impairment, and problems with coordination or balance
• Recurrent bleeding: In some cases, there is a risk of recurrent bleeding in individuals who have experienced an initial intracerebral hemorrhage. This can further exacerbate brain damage and increase the risk of complications
• Seizures: Intracerebral hemorrhage can trigger seizures in some individuals. Seizures can cause further neurological impairment and require appropriate management
• Hydrocephalus: In rare cases, intracerebral hemorrhage can disrupt the normal flow and absorption of cerebrospinal fluid, leading to hydrocephalus. This condition is characterized by an accumulation of fluid within the brain, which can result in symptoms such as headaches, cognitive changes, and gait disturbances
• Cognitive and functional impairments: Intracerebral hemorrhage can have long-term effects on cognitive function, including memory problems, difficulties with attention and concentration, and challenges with executive functions. Functional impairments may also arise, affecting activities of daily living, mobility, and independence
• Emotional and psychological effects: Intracerebral hemorrhage can have a significant emotional and psychological impact on individuals and their families. Depression, anxiety, emotional lability, and personality changes are common complications

Certain complications that can initiate from Intracerebral haemorrhage are: increased intracranial pressure, brain edema (swelling of brain),seizures, paralysis on one side of body. 

Prompt medical attention, appropriate management, and rehabilitation can help minimize the impact of these complications and support recovery. 

FAQs

How can I prevent intracerebral hemorrhage

To prevent intracerebral hemorrhage, it is essential to maintain a healthy lifestyle. This includes controlling blood pressure through regular monitoring and appropriate management, managing chronic conditions like diabetes and high cholesterol, avoiding excessive alcohol consumption, quitting smoking, and adopting a healthy diet and regular exercise routine. It is also important to be cautious with anticoagulant use, prevent head injuries by taking safety precautions, manage stress, and attend regular medical check-ups to monitor overall health and address any risk factors. Consulting with a healthcare professional is crucial to receive personalized guidance and recommendations based on individual circumstances.

How common is intracerebral hemorrhage

Intracerebral hemorrhage is a less common type of stroke compared to ischemic stroke. It accounts for approximately 8-15% of all stroke cases.² Its prevalence varies across different populations and regions. Risk factors such as hypertension and older age contribute to the incidence of intracerebral hemorrhage. While less common, it remains a significant health concern requiring attention and appropriate management.

Who are at risks of intracerebral hemorrhage

• Hypertension: High blood pressure is a major risk factor, as it damages blood vessel walls and cause it to burst
• Age: Individuals with age of over 55 years old are more susceptible to intracerebral hemorrhage
• Coagulation disorders: Conditions that affect clotting of blood, such as hemophilia or certain medications, increases bleeding and intracerebral hemorrhage
• Cerebral amyloid angiopathy (CAA): CAA, a disorder that causes amyloid protein to accumulate in brain blood vessels raises the possibility of intracerebral hemorrhage, particularly among elderly people
• Drug use: Illicit drugs, such as cocaine or amphetamines, can raise blood pressure and increase the risk of intracerebral hemorrhage

When should I see a doctor

Haemorrhages frequently grow during the initial three hours in a minimum of 33% of instances, and the extent of the haemorrhage strongly corresponds with results (the greater the haemorrhage, the worse the prognosis).³

Summary

Intracranial stroke, also known as intracerebral stroke, refers to a type of stroke caused by bleeding within the brain tissue itself. It occurs when a blood vessel in the brain ruptures, leading to the release of blood into the surrounding brain tissue. This can result in a disruption of blood flow, oxygen supply, and nutrient delivery to the affected area, leading to brain damage. Intracranial stroke can cause various neurological symptoms, such as sudden and severe headache, weakness or paralysis on one side of the body, changes in vision or speech, and loss of consciousness.⁴

Prompt medical attention is crucial for diagnosis, treatment, and management of intracranial stroke to minimize the potential complications and optimize recovery.