Deep intracerebral hemorrhage

Causes and Risks:
Intracerebral hemorrhage occurs in about 2 out of 1,000 people. It can affect any person regardless of age, sex, or race. Bleeding can occur in any part of the brain, and blood may accumulate in the tissues 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 may occur in other brain structures such as the thalamus, basal ganglia, pons, or cerebellum (deep intracerebral hemorrhage). Of the deep structures, intracerebral hemorrhage that is not caused by trauma most commonly occurs in the basal ganglia.

Intracerebral hemorrhage may be caused by head injury (trauma) or abnormalities of the blood vessels ( cerebral aneurysm or angioma--tumors involving the blood vessels). 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.

Bleeding in the brain irritates the brain tissues causing swelling (cerebral edema). It may collect into a mass (hematoma). Both cerebral edema and the presence of a hematoma within the brain will place increasing pressure on the brain tissues and eventually destroy them. Symptoms will vary depending on the extent of damage and the location of the bleed.

Risks for intracerebral hemorrhage, in addition to the causative disorders, includes various blood or bleeding disorders ( disseminated intravascular coagulation (DIC) , hemophilia , sickle cell anemia , leukemia , decreased 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.

Prevention:
Treatment or control of causative and risk-related disorders may reduce the risk of developing intracerebral hemorrhage . High blood pressure should be treated as appropriate; do not stop taking medications unless advised to do so by the health care provider.

Minimize the risk of head injury by using appropriate safety equipment and safety precautions in sports, recreation. and work. For example, use hard hats, bicycle or motorcycle helmets, and seat belts. Do not dive into water if the depth of water is unknown or if rocks may be present under the surface of the water.

Symptoms:

Additional symptoms that may be associated with this disease:

Note: Symptoms vary depending on the location of the bleed and the amount of brain tissue affected. Symptoms most commonly develop suddenly, without warning, often during activity. They may be episodic or develop in a progressively worsening manner in some cases.

Signs and Tests:
Neuromuscular examination may indicate increased intracranial pressure or decreases in specific brain functions. The specific pattern of symptoms and function changes may indicate which of the deep brain tissues are affected. For example, sudden nausea , vomiting , loss of balance , headache , and rapid decrease in consciousness may indicate a bleed in the cerebellum. Eye examination may show swelling of the optic nerve from pressure in the brain, or there may be changes in eye movement. Abnormal reflexes may be present, or there may be abnormal levels of normal reflexes.

Tests to determine the amount and cause of bleeding include:

Deep intracerebral hemorrhage may be confirmed, and the exact location and amount of bleeding determined by:



Treatment:
Deep intracerebral hemorrhage is a severe condition requiring prompt medical attention even if symptoms are episodic or progressive. It may develop quickly into a life-threatening situation. Treatment goals include lifesaving interventions, life support measures, and control of symptoms. Treatment varies depending on the specific location, extent, and cause of the bleeding .

Surgical removal of hematomas may be appropriate, especially if there is a hematoma in the cerebellum. Surgical repair or removal of structures causing the bleed (repair of cerebral aneurysm , arteriovenous malformation ) may be appropriate in some cases.

Medicines used may include corticosteroids or diuretics to reduce swelling , anticonvulsants to control seizures , analgesics to control pain, or others. Other treatments may be recommended depending on the condition of the person and the symptoms which develop.

Prognosis:
The outcome is highly variable. Death may occur rapidly despite prompt medical treatment. Recovery may occur completely or with any level of permanent loss of brain functions. Medications, surgery, or other treatments may have severe side effects.

Complications:

  • stroke
  • permanent loss of any brain function
  • complications of surgery
  • side effects of medications used to treat the disorder (see the specific medication)
  • hydrocephalus , especially if blood is in the subarachnoid space or the ventricle



Call Your Healthcare Provider:
Call your health care provider if severe headache with nausea , vomiting , decreased vision , numbness , or tingling occurs.

Go to the emergency room or call the local emergency number (such as 911) if other symptoms of deep intracerebral hemorrhage develop. Emergency symptoms include difficulty breathing , seizures , loss of ability to move or swallow, sudden change in mental state , and loss of consciousness .