Intracranial Hemorrhage
Definition
Intracranial hemorrhage (ICH) is bleeding within the brain that happens when a blood vessel in the head ruptures or leaks. ICH accounts for approximately 8 to 13 percent of all strokes . Bleeding into the brain irritates the nervous tissue and causes swelling, which increases intracranial pressure. The disruption of blood supply and compression results in a rapid destruction of tissue. The consequence is a loss or impairment of the body functions controlled by the affected part of the brain. Hemorrhagic strokes are more likely to result in death or major disability than ischemic strokes — those caused by blockage.
Causes
Intracranial hemorrhage most often happens as a result of damage to vessel walls caused by high blood pressure. Other causes include the rupture of vessel abnormalities, such as an aneurysm or arteriovenous malformation , or apoplexy of a tumor or infected area. Head trauma also is a common cause of ICH.
Risk Factors
- high blood pressure
- bleeding disorders, such as hemophilia
- sickle cell anemia
- leukemia
- use of blood thinning medication
- liver disease
- brain tumors
- drug abuse (methamphetamines or cocaine)
Symptoms
The symptoms of intracranial hemorrhage are determined by the area of the brain affected and the extent of the bleeding. Symptoms may include:
- severe headache, which may worsen with positional changes
- nausea or vomiting
- changes in consciousness
- visual disturbances, including loss of vision, changes in pupil size, uncontrollable eye movements, and eyelid drooping
- stiffness in the neck muscles
- numbness or tingling
- weakness
- paralysis
- difficulty speaking or understanding speech
- seizure
Diagnosis
A CT scan of the head will show areas of hemorrhage clearly. Lab studies also may be ordered to identify the cause of the hemorrhage and the risk of another hemorrhage. These may include blood tests to assess platelet count, toxicology screenings, liver and kidney function tests, and cerebral angiography.
Treatment
Treatment for intracranial hemorrhage depends on the location, extent, and duration of the bleed, as well as the general condition of the patient. Surgery may be required to drain the affected area of blood buildup or to repair the source of the bleed, such as an arteriovenous malformation or aneurysm.
Intraparenchymal hematomas, which occur when blood pools in the white matter of the brain, can be approached surgically under endoscopic visualization. Under computerized guidance an 11.5 mm tube is inserted into the brain to directly expose the hematoma. The surgery is performed using microsurgical bimanual dissection and the instruments are passed inside the tube – sharing the space of the endoscope – to reach the lesion. This technique accurately avoids large cuts in the brain to reach deeply located hematomas. It is called the “endoport” technique.
Treatment with drugs that promote clotting can reduce the progression of hematomas if given within four hours of the onset of bleeding. Medications also may be given to reduce blood pressure and to treat the symptoms of the hemorrhage, such as headache, fever and seizure.
Prevention
The risk of intracranial hemorrhages can be reduced by treating and controlling underlying conditions, including:
- high blood pressure
- hemophilia
- aneurysms
- arteriovenous malformations