Intracerebral Hemorrhage

by Elias A. Giraldo, MD, MS

NOTE: This is the Consumer

Version. DOCTORS: Click here for the
Professional Version

Stroke (CVA)

Overview of Stroke
Ischemic Stroke
Transient Ischemic Attacks
Overview of Hemorrhagic Stroke
Intracerebral Hemorrhage
Subarachnoid Hemorrhage

An intracerebral hemorrhage is bleeding within the

brain.

Intracerebral hemorrhage usually results from chronic high blood pressure.

The first symptom is often a severe headache.

Diagnosis is based mainly on results of imaging tests.

Treatment may include managing problems that may contribute to bleeding

(such as lowering blood pressure if it is very high) and, rarely, surgically
removing 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 (bleeding around,
rather than within, the brainsee 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. One or
both eyes may be unable to move in certain directions. As a
result, the eyes may point in different directions. 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 usually suspect intracerebral hemorrhage based on
symptoms and results of a physical examination. Computed
tomography (CT) or magnetic resonance imaging (MRI) is done
to confirm the diagnosis. 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.
Doctors sometimes do CT angiography (see CT Angiography) to
determine whether the hemorrhage is continuing to expand. If
it is expanding, the outlook is poor.
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 often large and
catastrophic, especially in people who have chronic high blood
pressure. About half 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 andwarfarin),
thrombolytic drugs, and antiplatelet drugs (such as aspirin) 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
Vitamin K, usually given intravenously
Transfusions of platelets
Transfusions of blood that has had blood cells and
platelets removed (fresh frozen plasma)
Intravenous administration of a synthetic product similar
to the proteins in blood that help blood clot (clotting
factors)
A solution that contains clotting factors and other proteins
that help blood clot (prothrombin complex concentrate)
High blood pressure is treated only if it is very high. Decreasing
blood pressure too rapidly or by too much can reduce the blood
supply to parts of the brain that have already been deprived of
blood because of the hemorrhage. Then, the lack of blood may
result in a stroke (an ischemic stroke) in those parts of the
brain.
Surgery to remove the accumulated blood and relieve pressure
within the skull, even if it may be lifesaving, 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
cerebellum. In such cases, a good recovery is possible.

Anticonvulsants are given if people have had seizures.