• Clinical science
  • Clinician

Intracerebral hemorrhage (ICH…)

Summary

Intracerebral hemorrhage (ICH) refers to bleeding within the brain parenchyma. The term should not be confused with “intracranial hemorrhage,” which encompasses any type of bleeding within the skull, i.e., extradural, subdural, subarachnoid, and intracerebral. The most significant risk factor for spontaneous ICH is arterial hypertension. Symptoms are often nonspecific (e.g., headache), but, depending on the affected vessel and cerebral region, focal neurologic deficits (e.g., hemiparesis) may occur. Compared to ischemic stroke, patients with ICH typically present with more severe headache and symptoms usually progress more rapidly. A noncontrast head CT, the most important diagnostic procedure, shows a hyperdense lesion in acute ICH and a hypodense lesion in hyperacute ICH. Treatment involves management of the underlying and accompanying conditions (e.g., controlling hypertension, reversing coagulopathy) and, in severe cases, neurosurgical intervention. Approximately half of patients with ICH die within 30 days.

See also overview of stroke, ischemic stroke, and subarachnoid hemorrhage for more information.

Definition

Epidemiology

  • ICH is responsible for approx. 10% of all strokes. [1][2]
  • Most commonly affects the deep structures of the brain [3]
  • Intraventricular extension occurs in approx. 30% of patients with ICH. [4]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[5][2][4][6][7]

Pathophysiology

References:[8][4]

Clinical features

References:[4][9]

Diagnostics

Initial evaluation

Subsequent evaluation

  • Laboratory studies
    • CBC
    • Coagulation parameters (PTT and INR)
    • Blood glucose level
    • Troponin
    • Toxicology screen
  • Angiography (e.g., CTA and/or MRA): to identify the source of the bleeding if the patient does not have any risk factors
  • EEG

References:[4][10]

Treatment

Medical therapy [11]

Surgical therapy [11]

Patients with signs of brain herniation should be operated on immediately!

References:[12][10][11][13]

Acute management checklist

Complications

References:[8][10][11][21]

We list the most important complications. The selection is not exhaustive.

Prognosis

Approximately 50% of all patients with ICH die within 30 days. [22]

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last updated 09/25/2020
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