Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is a type of stroke where bleeding occurs within the brain tissue itself. The blood clot causes damage to the brain tissue in that area leading to signs and symptoms. Also, the blood clot may lead to increased pressure in the brain and subsequent symptoms. The bleeding may occur due to a number of reasons such as

• high blood pressure
• head trauma
• arteriovenous malformation rupture
• brain aneurysm rupture
• diseases that cause increased tendency of bleeding (Eg., Hemophilia)
• treatment with blood thinner medicines (Eg., Aspirin, Warfarin, Clopidogrel, Heparin)
• tumors within the brain
• cocaine and amphetamine abuse
• amyloid angiopathy (bleeding due to degeneration of arteries in elderly people)

How common is intracerebral hemorrhage?

About 10% of all strokes occur due to intracerebral hemorrhage while 80% occur due to ischemic stroke (due to blockage of arteries supplying the brain). This translates to about 12-15 cases per 100,000/year in general population. About 40% of patients with intracerebral hemorrhage eventually die and a large proportion of the rest are left with permanent disability. Advancing age and uncontrolled high blood pressure are major risk factors for ICH.

Signs and Symptoms

• Headache
• Nausea and vomiting
• weakness of arm, leg
• facial droop
• confusion, lethargy and loss of consciousness
• speech difficulty
• seizures
• visual loss
• difficulty in walking

How is the diagnosis made?

• A CT scan is the best imaging modality to detect acute bleeding within the brain
• CT angiogram / MRI / MR angiogram and a digital subtraction angiogram may be required to detect the exact cause of bleeding.

How is intracerebral hemorrhage treated?

• The first step in the treatment of intracerebral hemorrhage is to determine the cause of bleed
• High blood pressure is controlled with medications
• If the bleeding leads to increased pressure in the brain, surgery may be needed to remove the clot and relieve the pressure. Surgical procedure may involve craniotomy and evacuation, stereotactic aspiration, draining fluid from the brain.

Recovery and Outcome

Outcome following intracerebral hemorrhage depends upon the cause, location and extent of bleed. Prompt diagnosis and treatment helps to minimize complications and long term sequelae.