CCRN Intracerebral Hemorrhage

CCRN Intracerebral Hemorrhage Overview

Intracerebral hemorrhage (ICH) is caused by bleeding within the brain tissue itself — a life-threatening type of stroke. A stroke occurs when the brain is deprived of oxygen and blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma. Treatment focuses on stopping the bleeding, removing the blood clot (hematoma), and relieving the pressure on the brain.

An ICH can occur close to the surface or in deep areas of the brain. Sometimes deep hemorrhages can expand into the ventricles – the fluid filled spaces in the center of the brain. Blockage of the normal cerebrospinal (CSF) circulation can enlarge the ventricles (hydrocephalus) causing confusion, lethargy, and loss of consciousness.

Signs and Symptoms

• headache, nausea, and vomiting
• lethargy or confusion
• sudden weakness or numbness of the face, arm or leg, usually on one side
• loss of consciousness
• temporary loss of vision
• seizures

Causes

• Hypertension: elevated blood pressure may cause tiny arteries to burst inside the brain. Normal pressure is 120/80 mm Hg.
• Blood thinners: drugs such as coumadin, heparin, and warfarin used to prevent clots in heart and stroke conditions may cause ICH.
• AVM: a tangle of abnormal arteries and veins with no capillaries in between.
• Aneurysm: a bulge or weakening of an artery wall.
• Head trauma: fractures to the skull and penetrating wounds (gunshot) can damage an artery and cause bleeding.
• Bleeding disorders: hemophilia, sickle cell anemia, DIC, thrombocytopenia.
• Tumors: highly vascular tumors such as angiomas and metastatic tumors can bleed into the brain tissue.
• Amyloid angiopathy: a buildup of protein within the walls of arteries.
• Drug usage: alcohol, cocaine and other illicit drugs can cause ICH.
• Spontaneous: ICH by unknown causes.

Treatment

Treatment may include lifesaving measures, symptom relief, and complication prevention. Once the cause and location of the bleeding is identified, medical or surgical treatment is performed to stop the bleeding, remove the clot, and relieve the pressure on the brain. If left alone the brain will eventually absorb the clot within a couple of weeks – however the damage to the brain caused by ICP and blood toxins may be irreversible.

Generally, patients with small hemorrhages (<10 cm3) and minimal deficits are treated medically. Patients with cerebellar hemorrhages (>3 cm3) who are deteriorating or who have brainstem compression and hydrocephalus are treated surgically to remove the hematoma as soon as possible. Patients with large lobar hemorrhages (50 cm3) who are deteriorating usually undergo surgical removal of the hematoma.