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Intracerebral Hemorrhage

What is intracerebral hemorrhage?

Intracerebral hemorrhage (ICH) is when blood suddenly bursts into brain tissue, causing damage to your brain.

Symptoms usually appear suddenly during ICH. They include headache, weakness, confusion, and paralysis, particularly on one side of your body. The buildup of blood puts pressure on your brain and interferes with its oxygen supply. This can quickly cause brain and nerve damage.

This is a medical emergency requiring immediate treatment. ICH isn’t as common as ischemic stroke (which occurs when a blood vessel to your brain is blocked by a clot), but it’s more serious.

Treatment depends on the amount of blood and the extent of brain injury that has occurred. Because the most common cause of ICH is related to high blood pressure, getting your blood pressure lowered and under control is the first key step. Sometimes surgery is required to relieve pressure from the accumulation of blood and to repair damaged blood vessels.

Long-term treatment depends on the hemorrhage location and the amount of damage. Treatment may include physical, speech, and occupational therapy. Many people have some level of permanent disability.

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Causes

What are the causes of intracerebral hemorrhage?

High blood pressure is the most common cause of ICH. In younger people, another common cause is abnormally formed blood vessels in the brain.

Other causes include:

  • head injury or trauma
  • ruptured cerebral aneurysm (a weak spot in a blood vessel that bursts)
  • arteriovenous malformation (a grouping of malformed blood vessels in your brain that disrupts normal blood flow)
  • use of blood thinners
  • bleeding tumors
  • cocaine or methamphetamine use (which can cause severe hypertension and lead to hemorrhage)
  • bleeding disorders (for example, hemophilia or sickle cell anemia)

Anyone can have an ICH, but your risk increases with age. According to the Mayfield Clinic, men are at slightly higher risk than women. Middle-aged people of Japanese or African-American descent are also at risk for ICH.

Symptoms

What are the symptoms of intracerebral hemorrhage?

Symptoms of ICH include:

  • sudden weakness, tingling, or paralysis in your face, arm, or leg, especially if it occurs on only one side of your 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 these symptoms, call 911 immediately.

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Diagnosis

How is intracerebral hemorrhage diagnosed?

If you have some symptoms of ICH, a doctor will perform a neurological exam. Imaging tests determine if you’re having an ischemic stroke (blockage) or a hemorrhagic stroke (bleeding).

Diagnostic testing for ICH may include a CT scan. This type of test creates images of your brain, which can confirm bleeding, and also assess for other evidence of trauma to your head.

An MRI scan may help your doctor see your brain more clearly to better identify the cause of the bleeding.

An angiogram uses X-ray technology to take pictures of blood flow within an artery, and can reveal any abnormalities with the blood vessels themselves, such as aneurysms or arteriovenous malformations.

Blood tests can identify immune system disorders, inflammation, and blood clotting problems that can cause bleeding in your brain.

Complications

What are the complications of intracerebral hemorrhage?

Depending on the location of the hemorrhage and how long your brain was without oxygen, complications may include:

  • impaired language skills
  • fatigue
  • problems with swallowing
  • vision loss
  • difficulty with sensations or movements on one side of the body
  • pneumonia
  • cognitive dysfunction (memory loss, difficulty reasoning), confusion
  • swelling on the brain
  • seizures
  • depression, emotional problems
  • fever
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Treatment

How is intracerebral hemorrhage treated?

Treatment within the first three hours of the onset of symptoms generally results in a better outcome.

Surgery can relieve pressure on your brain and repair torn arteries. Certain medications can help manage symptoms, such as painkillers to ease severe headaches. Drugs may be necessary to control blood pressure. If your doctor determines that you’re at risk for seizures, you may need to take antiepileptic drugs.

Long-term treatment will be needed to overcome symptoms caused by damage to your brain. Depending on your symptoms, treatment may include physical and speech therapy to help restore muscle function or improve communication. Occupational therapy may help you regain certain skills and independence by practicing and modifying everyday activities.

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Prevention

How can I prevent intracerebral hemorrhage?

You can decrease your chances of ICH by:

  • not smoking
  • treating heart disease
  • treating high blood pressure
  • keeping diabetes under control
  • maintaining a healthy lifestyle
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Outlook

What is the long-term outlook?

Recovery following ICH differs greatly from person to person and will depend on a variety of factors. These include 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 necessary.

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.

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