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Intracerebral hemorrhage

Last updated: March 3, 2021

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Intracerebral hemorrhage (ICH) refers to bleeding within the brain parenchyma. The term should not be confused with “intracranial hemorrhage,” which encompasses any type of bleeding within the skull, i.e., extradural, subdural, subarachnoid, and intracerebral. The most significant risk factor for spontaneous ICH is arterial hypertension. Symptoms are often nonspecific (e.g., headache), but, depending on the affected vessel and cerebral region, focal neurologic deficits (e.g., hemiparesis) may occur. Compared to ischemic stroke, patients with ICH typically present with more severe headache and symptoms usually progress more rapidly. A noncontrast head CT, the most important diagnostic procedure, shows a hyperdense lesion in acute ICH and a hypodense lesion in hyperacute ICH. Treatment involves management of the underlying and accompanying conditions (e.g., controlling hypertension, reversing coagulopathy) and, in severe cases, neurosurgical intervention. Approximately half of patients with ICH die within 30 days.

See also overview of stroke, ischemic stroke, and subarachnoid hemorrhage for more information.

  • ICH is responsible for approx. 10% of all strokes. [1][2]
  • Most commonly affects the deep structures of the brain [3]
  • Intraventricular extension occurs in approx. 30% of patients with ICH. [4]

Epidemiological data refers to the US, unless otherwise specified.

References:[2][4][5][6][7]

References:[4][8]

References:[4][9]

References:[8][17][18][19]

We list the most important complications. The selection is not exhaustive.

Approximately 50% of all patients with ICH die within 30 days. [20]

Initial evaluation

Subsequent evaluation

References:[4][18]

Medical therapy [17]

Surgical therapy [17]

Patients with signs of brain herniation should be operated on immediately!

References:[17][18][21][22]

  1. Kasper DL, Fauci AS, Hauser S, Longo D, Jameson LJ, Loscalzo J . Harrisons Principles of Internal Medicine . McGraw-Hill Medical Publishing Division ; 2016
  2. Caplan LR, Kasner SE, Dashe JF. Etiology, Classification, and Epidemiology of Stroke. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/etiology-classification-and-epidemiology-of-stroke.Last updated: March 14, 2017. Accessed: March 28, 2017.
  3. Rordorf G, McDonald C, Kasner SE, Wilterdink JL. Spontaneous Intracerebral Hemorrhage: Pathogenesis, Clinical Features, and Diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/spontaneous-intracerebral-hemorrhage-pathogenesis-clinical-features-and-diagnosis.Last updated: December 4, 2013. Accessed: March 28, 2017.
  4. Berlit P. Diagnosis and treatment of cerebral vasculitis. Ther Adv Neurol Disord. 2010; 3 (1): p.29–42.
  5. Chen M. Stroke as a Complication of Medical Disease. Semin Neurol. 2009; 29 (2): p.154-162. doi: 10.1055/s-0029-1213735 . | Open in Read by QxMD
  6. Daroff RB, et al.. Bradley's Neurology in Clinical Practice. Elsevier
  7. Delcourt et al.. Intracerebral hemorrhage location and outcome among INTERACT2 participants. Neurology. 2017; 88 (15): p.1408–1414. doi: 10.1212/WNL.0000000000003771 . | Open in Read by QxMD
  8. Liebeskind DS. Intracranial Hemorrhage. Intracranial Hemorrhage. New York, NY: WebMD. http://emedicine.medscape.com/article/1163977-overview. Updated: May 10, 2016. Accessed: March 1, 2017.
  9. Hemphill JC, Greenberg SM, Anderson CS et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke. 2015; 46 (7). doi: 10.1161/STR.0000000000000069 . | Open in Read by QxMD
  10. Brunicardi F, Andersen D, Billiar T, et al.. Schwartz's Principles of Surgery. McGraw-Hill Education ; 2014
  11. Rordorf G, McDonald C, Kasner SE, Wilterdink JL. Spontaneous Intracerebral Hemorrhage: Treatment and Prognosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/spontaneous-intracerebral-hemorrhage-treatment-and-prognosis.Last updated: May 21, 2014. Accessed: March 29, 2017.
  12. Agabegi SS, Agabegi ED. Step-Up To Medicine. Wolters Kluwer Health ; 2015
  13. Balami JS, Buchan AM. Complications of intracerebral haemorrhage. Lancet Neurol. 2012; 11 (1): p.101-118. doi: 10.1016/S1474-4422(11)70264-2 . | Open in Read by QxMD
  14. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  15. Fogelholm R, Murros K, Rissanen A, Avikainen S. Long term survival after primary intracerebral haemorrhage: a retrospective population based study.. J Neurol Neurosurg Psychiatry. 2005; 76 (11): p.1534-8. doi: 10.1136/jnnp.2004.055145 . | Open in Read by QxMD
  16. Claude Hemphill J, Lam A. Emergency Neurological Life Support: Intracerebral Hemorrhage. Neurocrit Care. 2017; 27 (S1): p.89-101. doi: 10.1007/s12028-017-0453-0 . | Open in Read by QxMD
  17. CHRISTENSEN TD, LARSEN TB. Precision and accuracy of point-of-care testing coagulometers used for self-testing and self-management of oral anticoagulation therapy. Journal of Thrombosis and Haemostasis. 2012; 10 (2): p.251-260. doi: 10.1111/j.1538-7836.2011.04568.x . | Open in Read by QxMD
  18. Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016; 375 (11): p.1033-1043. doi: 10.1056/nejmoa1603460 . | Open in Read by QxMD
  19. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) investigators.. Antihypertensive treatment of acute cerebral hemorrhage.. Crit Care Med. 2010; 38 (2): p.637-48. doi: 10.1097/CCM.0b013e3181b9e1a5 . | Open in Read by QxMD
  20. Anderson CS, Heeley E, Huang Y, et al. Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage. N Engl J Med. 2013; 368 (25): p.2355-2365. doi: 10.1056/nejmoa1214609 . | Open in Read by QxMD
  21. Broderick J, et al.. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults. Stroke. 2007; 38 (6): p.2001-2023. doi: 10.1161/strokeaha.107.183689 . | Open in Read by QxMD
  22. Ropper AH. Management of raised intracranial pressure and hyperosmolar therapy. Pract Neurol. 2014; 14 (3): p.152-158. doi: 10.1136/practneurol-2014-000811 . | Open in Read by QxMD
  23. Helbok R, Kurtz P, Schmidt JM, et al. Effect of mannitol on brain metabolism and tissue oxygenation in severe haemorrhagic stroke. Journal of Neurology, Neurosurgery & Psychiatry. 2010; 82 (4): p.378-383. doi: 10.1136/jnnp.2009.198754 . | Open in Read by QxMD