Intracerebral hemorrhage (ICH) is a sudden bleed in the brain tissue or ventricles. It carries a high rate of death or functional disability. ICH can be caused by a malformation of blood vessels, blood clotting disorders, cancer, hypertension, and other diseases or injuries affecting the blood vessels.
Symptoms of ICH require immediate diagnostic tests and imaging. Treatment is focused on stabilizing the patient, reducing elevated intracranial pressure, and reversing the effects of any anticoagulant medications.
ICH can lead to serious complications. There is a risk of seizures which can occur any time, though it can even be one of the first symptoms. Increased intracranial pressure resulting from swelling of the brain or bleeding inside the skull can also occur. Increased intracranial pressure, in turn, can lead to several serious complications. It can deprive the brain of oxygen, leading to permanent brain damage or death. It can also cause herniation of the brain into the spinal canal, again leading to death.
Additional acute complications include:
- Rebleeding of the hemorrhage
- A second hemorrhage at another location
- Cranial nerve damage
If the skull is fractured, leakage of cerebrospinal fluid into ear or nasal passages is another complication.
Recovery from an ICH can be prolonged. Some complications that can arise during that period of confinement are:
- Urinary tract infection
- Loss of bladder control
Functional impairments resulting from ICH can include difficulty speaking, difficulty with movement on one side of the body, loss of sensation on one side of the body, difficulty thinking or attending.
ICH is the most catastrophic type of stroke a person can suffer. Outcomes for ICH are often dire. A clinical grading scale, the ICH score, is used to predict 30-day mortality. The score takes into account factors such as age, sex, and risk factors, as well as clinical information like glucose levels, blood pressure, and CT imaging results.
The localization of the hemorrhage plays a role in prognosis, as well as the volume of the hematoma.
Overall 30-day mortality in one study was 34.6%. After six months, the mortality rate was 38.6%. Another 38.6% had a good outcome, and 22% were alive but with significant impairment.
During recovery, movement is often impaired at first, and regained slowly over several months. Most patients will have some movement impairment that is permanent. Impaired speech usually improves with time, often over a period of months or years following the ICH event.
During the process of recovery, the body removes dead tissue in the brain. Function initially lost may be regained as some functions previously performed by the damaged areas can be taken on by other parts of the brain. If there is damage to a hemisphere of the brain, many patients will begin to compensate by using both sides of the brain to perform a task previously assigned to the damaged hemisphere.
Patients recovering from ICH should care for themselves by managing blood pressure, diabetes, and cholesterol levels. They should maintain a healthy lifestyle and refrain from smoking for the best chance at full recovery.
Reviewed by Afsaneh Khetrapal BSc (Hons)
- Medical Disability Guidelines, http://www.mdguidelines.com/intracranial-hemorrhage/complications
- Predicting Mortality in Spontaneous Intracerebral Hemorrhage, http://stroke.ahajournals.org/content/37/4/1038
- UW Medicine, Intracerebral Hemorrhage, http://www.uwmedicine.org/health-library/Pages/intracerebral-hemorrhage.aspx