Deep intracerebral hemorrhage is a type of stroke caused by bleeding within the deep structures of the brain (thalamus, basal ganglia, pons, and cerebellum).

Alternative Names

Hemorrhage - intracerebral (deep); Intracranial bleed

Causes, incidence, and risk factors

Intracerebral hemorrhage can affect any person regardless of age, sex, or race, though it is more common in older people. Bleeding can occur in any part of the brain, and blood may accumulate in the tissues or in the subarachnoid space (space between the brain and the membranes covering the brain, the meninges). Bleeding 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. Intracerebral hemorrhage that is not caused by trauma most commonly occurs in the basal ganglia. Intracerebral hemorrhage can be caused by head injury (trauma), bleeding into a tumor, abnormalities of the blood vessels ( cerebral aneurysm or angioma --tumors involving the blood vessels) or an abnormality in blood clotting. When it is not caused by one of these conditions, intracerebral hemorrhage 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 vary depending on the extent of damage and the location of the bleed. Risk factors for intracerebral hemorrhage, in addition to the causative disorders, include the following:

Signs and tests

Neurological 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 or brainstem. 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. Tests to determine the cause of bleeding include:

Treatment

Deep intracerebral hemorrhage is a severe condition requiring prompt medical attention -- even if symptoms are episodic. It can develop quickly into a life-threatening situation. Treatment goals include 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, and others. Other treatments may be recommended, depending on the condition of the person and the symptoms that develop.

Expectations (prognosis)

The outcome is highly variable. Prognosis depends on the degree of swelling and size of the hematoma. Death may occur quickly 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

Calling your health care 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 loss of sensations, sudden change in mental state , and loss of consciousness .

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 you do not know the depth of the water or if there may be rocks under the surface. If you are taking a blood thinner (such as coumadin), follow your doctor's instructions on how to take the medicine and when to have blood tests for monitoring the medication.