Intracerebral Hemorrhage

Overview

An intracerebral hemorrhage (ICH) is a blood clot that forms within the brain tissue due to a rupture of small artery.

Symptoms

Symptoms usually involve sudden onset of stroke like symptoms such as:

• Numbness of the face, arm or leg on one side of the body
• Weakness of the face, arm or leg on one side of the body
• Sudden and severe headache with no apparent cause
• Difficulty speaking or understanding language
• Dizziness, loss of balance, or loss in coordination
• Visual loss
• Other symptoms include sudden onset of headache, seizures or loss of consciousness

​Prevention

Proper management and control of high blood pressure will help to minimise development of intracerebral hemorrhage.

Causes

The possible causes are due to:

• Long-standing high blood pressure which may be undiagnosed
• Abnormal blood vessels called arteriovenous malformation (AVM)
• Cerebral aneurysms
• Brain tumours
• Traumatic brain injury

Diagnosis

Diagnosis usually begins with a neurological exam and includes computed tomography (CT) and magnetic resonance imaging (MRI) scans of the brain.

Additional tests such as a cerebral angiogram may be necessary to exclude the other possible causes of an ICH as listed above.

A CT brain scan showing a large blood clot with surrounding pressure and swelling of the brain structures.

Treatment Options

• Medications for control of blood pressure and reduction of brain swelling will be instituted. If an individual is in a coma, intensive care support will be needed.
• If the blood clot is small, the patient needs to be monitored closely for progressive deterioration from an enlarging clot.
• If the blood clot is large and the patient is already unconscious, then surgery needs to be performed urgently for evacuation of the blood clot and to relieve pressure from the surrounding brain structures.
• If an abnormal blood vessel or AVM is found, surgery may be required to correct and prevent future brain hemorrhage.
• If a tumor is found, surgery may be required to remove it.

Outcome

Factors that affect prognosis after intracerebral hemorrhage are:

• Patient's age and concurrent medical conditions
• Initial neurological state of consciousness
• Size and location of the hematoma
• Presence of blood in the ventricles

Patients with a small hematoma may have residual neurological deficits and may benefit from inpatient rehabilitation.

The prognosis however is generally poor for patients with large ICH and long-term mental and physical disability usually occurs.