Intracerebral Hemorrhage

Contributed by: Yousuf Qaseem, University of New Mexico School of Medicine, 1 University of New Mexico, Albuquerque, NM 87131
Overview
  • Intracerebral (or intraparenchymal) hemorrhages are a subtype of intracranial hemorrhage due to bleeding within the brain parenchyma and occur in the context of a diverse variety of risk factors. Rapid identification and treatment is necessary to prevent significant neurological sequelae.
Risk Factors
  • Hypertension: Hypertensive intracerebral hemorrhage often occurs in the basal ganglia as a result of bleeding from a small, penetrating artery.
  • Cerebral Amyloid Angiopathy: Deposition of amyloid can weaken vessels and increase their tendency to bleed. These patients are often elderly and can develop lobar hemorrhages.
  • Sympathomimetics: Drugs of abuse such as cocaine and methamphetamine may increase risk of intraparenchymal hemorrhage by induction of hypertension, although the exact mechanism is unknown. These drugs can also cause ischemic strokes through cerebral vasospasm.
  • Other: Other causes of intracerebral hemorrhage include neoplasm, anticoagulant therapy and head trauma.
Morphology
  • Intracerebral hemorrhage may cause focal areas of hyperdensity on non-contrast head CT, depending upon the site of the hemorrhage. Hypertensive hemorrhage often occurs in the basal ganglia. In those associated with neoplasms, hemorrhage is typically adjacent to the neoplastic mass.
Clinical Features and Consequences
  • Depending upon the etiology of the hemorrhage, symptoms may evolve over minutes to hours. Acute headache is common, as well as nausea and vomiting. Depending on the location of the hemorrhage, focal neurological deficits such as hemiparesis, ataxia, dysarthria, or vision changes may occur.
  • If elevations in intracranial pressure (ICP) are severe, patients may experience stupor, coma and death as a result of tonsillar or uncal herniation (see “Epidural Hematoma”, section on Clinical Features and Consequences). Treatment is dependent upon the etiology of the hemorrhage, and is typically directed at correction of the underlying cause, such as reducing hypertension, if applicable.

Further Reading
  • Naidech AM. 2011. "Intracranial Hemorrhage." American Journal of Respiratory and Critical Care Medicine 184.9 (2011): 998-1006


To cite this article
  • Qaseem, Y, “Epidural Hematoma” in Pathway Medicine: An Introduction to Clinical Medicine", PathwayMedicine.org (2017).