Intracerebral hemorrhage

Alternative names:

hemorrhage - intracerebral; intracranial hemorrhage; thalamic hemorrhage

Definition:

A condition where there is loss of blood within the brain. See also hemorrhagic stroke.

Causes, incidence, and risk factors:

Internal bleeding can occur in any part of the brain, and blood may accumulate in the tissues and/or in the space between the brain and the membranes covering the brain (subarachnoid space). It may be isolated to part of one cerebral hemisphere (lobar intracerebral hemorrhage) or occur in other brain structures, such as the thalamus, basal ganglia, pons, or cerebellum (deep intracerebral hemorrhage).

Intracerebral hemorrhage occurs in about 2 out of 1,000 people. It can affect any person regardless of age, sex, or race.

Intracerebral hemorrhage may be caused by trauma (brain injury) or abnormalities of the blood vessels (aneurysm or angioma). When it is not caused by one of these conditions, it is most commonly associated with high blood pressure (hypertensive intracerebral hemorrhage). In some cases, no cause can be found.

Blood irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both cerebral edema and the presence of a hematoma within the brain will put increasing pressure on the brain tissues of the brain and destroy them.

Symptoms vary depending on the location of the bleed and the amount of brain tissue affected. Symptoms usually develop suddenly, without warning, often during activity. They may occasionally develop in a stepwise, episodic manner or in a progressive manner.

The risks for intracerebral hemorrhage, in addition to the causative disorders, include various blood and bleeding disorders (disseminated intravascular coagulation, hemophilia, sickle cell anemia, leukemia, and decreased levels of blood platelets); use of aspirin or anticoagulant medications ("blood thinners"); liver disease (which is associated with increased bleeding risk); and cerebral amyloid or other brain tumors.

Premature infants (born earlier than 35 weeks gestation) will sometimes have bleeding into the ventricles (fluid-filled spaces) in the brain. This type of bleed is called intra-ventricular hemorrhage or IVH. This occurs in the first day or so of life and is usually unpreventable. The outcome is variable (depending on the severity of bleed) and ranges from a normal child to severe disability. Diagnosis is by ultrasound and usually done in an intensive care nursery.