An intracerebral hemorrhage (ICH) occurs when blood suddenly bursts into brain tissue, causing damage to the brain, which may present symptoms similar to that of a stroke. Lobar intracerebral hemorrhages occur in the cerebral lobes outside of the basal ganglia. The basal ganglia are a structure located in the cerebrum (the largest part of the brain) that aids in motor control, procedural learning, eye movement, and cognitive function.
Stroke-like symptoms usually appear suddenly during ICH, causing symptoms that include headache, weakness, confusion, and paralysis, particularly on one side of the body. The buildup of blood puts pressure on the brain and interferes with its oxygen supply. This can quickly cause brain and nerve damage.
This is a medical emergency requiring immediate treatment. ICH is not as common as ischemic stroke (when a blood vessel is blocked by a clot), but is more serious.
Treatment generally involves surgery to repair damaged blood vessels. Depending on the location of the hemorrhage and the amount of damage, long-term treatment may include physical, speech, and occupational therapy. Most people have some level of permanent disability.
Symptoms of ICH include:
- sudden weakness, tingling, or paralysis in the face, arm, or leg, especially if it occurs on only one side of the body
- sudden onset of severe headache
- trouble swallowing
- trouble with vision in one or both eyes
- loss of balance and coordination, dizziness
- trouble with language skills (reading, writing, speaking, understanding)
- nausea, vomiting
- apathy, sleepiness, lethargy, loss of consciousness
- confusion, delirium
This is a serious medical condition. If you or someone near you is having symptoms of stroke, call 911 immediately.
High blood pressure is the most common cause of intracerebral hemorrhage. In younger people, another common cause is abnormally formed blood vessels in the brain. Other causes include:
- head injury or trauma
- blood clot that blocks an artery in the brain
- ruptured cerebral aneurysm (weak spot in a blood vessel that bursts)
- arteriovenous malformation (a grouping of malformed blood vessels in the brain that disrupts normal blood flow)
- use of blood thinners
- bleeding tumors
- cocaine use, which can cause severe hypertension and lead to hemorrhage
- bleeding disorders such as hemophilia and sickle cell anemia
Anyone can have an intracerebral hemorrhage, but your risk increases with age. According to the Mayfield Clinic, men are at higher risk than women, as are middle-aged people of Japanese or African-American descent (Mayfield Clinic, 2009).
If you have some symptoms of ICH, a neurological exam will be performed. Imaging tests are used to determine if you are having an ischemic stroke (blockage) or a hemorrhagic (bleeding) stroke. Diagnostic testing for ICH may include:
Computed tomography (CT scan): This type of test creates images of the brain, which can detect skull fractures or confirm bleeding.
Magnetic resonance imaging (MRI): This type of imaging test may help your doctor see the brain more clearly to better identify the cause of the bleeding.
Angiogram: This test uses X-ray technology to take pictures of blood flow within an artery.
Blood tests may also be used to identify immune system disorders, inflammation, and blood clotting problems that can cause bleeding in the brain.
Treatment within the first three hours of the onset of symptoms generally results in a better outcome.
Surgery can relieve pressure on the brain and repair torn arteries. In addition, certain medications may be prescribed to manage symptoms, such as painkillers to ease severe headaches. Antianxiety drugs may be necessary to control blood pressure. If your doctor determines that you are at risk for seizures, antiepileptic drugs may be prescribed.
Long-term treatment will be needed to overcome symptoms caused by damage to the brain. Depending on your symptoms, treatment may include physical and speech therapy to help restore muscle function or improve communication. Occupational therapy may help a person regain certain skills and independence by practicing and modifying everyday activities.
Depending on the location of the hemorrhage and how long your brain was deprived of oxygen, complications may include:
- impaired language skills
- problems with swallowing
- vision loss
- difficulty with sensations or movements on one side of the body
- cognitive dysfunction (memory loss, difficulty reasoning), confusion
- swelling on the brain
- depression, emotional problems
Recovery following ICH differs greatly from person to person, and will depend on a variety of factors, including your age and overall health, the location of the hemorrhage, and the extent of the damage.
Some people may take months or years to recover. Most ICH patients have some long-term disability. In some cases, around-the-clock or nursing home care may be needed. According to The University of Washington Medical Center (UWM), about 40 percent of ICH patients die within the first month (UWM).
Stroke support groups can help people and families cope with long-term care. Your doctor or hospital can provide information about support groups that meet in your area.