What is an intracerebral hemorrhage?
Tiny arteries bring blood to areas deep inside the brain. High blood pressure (hypertension) can cause these thin-walled arteries to rupture, releasing blood into the brain tissue. Enclosed within the rigid skull, clotted blood and fluid buildup increases pressure that can crush the brain against the bone or cause it to shift and herniate. As blood spills into the brain, the area that artery supplied is now deprived of oxygen-rich blood – called a stroke. As blood cells within the clot die, toxins are released that further damage brain cells in the area surrounding the hematoma.
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.
What are the symptoms of an intracerebral hemorrhage?
If you experience symptoms of an ICH, call 911 immediately! Symptoms usually come on suddenly and can vary depending on the location of the bleed. Common symptoms include:
- 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
What are the causes of an intracerebral hemorrhage?
The most common causes of an intracerebral hemorrhage include:
- Hypertension
- Blood thinner medications
- Aneurysm
- Various types of head trauma
- Bleeding disorders, like hemophilia, sickle cell anemia, DIC, or thrombocytopenia
- 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
How is an ICH diagnosed?
When a person is brought to the emergency room with a suspected brain hemorrhage, doctors will learn as much about their symptoms, current and previous medical problems, medications, and family history. The person’s condition is assessed quickly. Diagnostic tests will help determine the source of the bleeding. Tests that may be conducted include:
- CT scan
- MRI scan
- Angiogram
What are treatment options for an ICH?
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 weeks – however the damage to the brain caused by ICP and blood toxins may be irreversible.
Surgical treatment: the goal of surgery is to remove as much of the blood clot as possible and stop the source of bleeding if it is from an identifiable cause such as an AVM or tumor. Depending on the location of the clot either a craniotomy or a stereotactic aspiration may be performed.
Immediately after an ICH, the patient will stay in the intensive care unit (ICU) for several weeks where doctors and nurses watch them closely for signs of rebleeding, hydrocephalus, and other complications. Once their condition is stable, the patient is transferred to a regular room.
ICH patients may suffer short-term and/or long-term deficits as a result of the bleed or the treatment. Some of these deficits may disappear over time with healing and therapy. The recovery process may take weeks, months, or years to understand the level of deficits incurred and regain function.
What are clinical trial opportunities for an ICH?
Clinical trials are research studies in which new treatments are tested in people to see if they are safe and effective. Studies can be sponsored by the National Institute of Health (clinicaltrials.gov) as well as private industry and pharmaceutical companies (www.centerwatch.com).