Intracerebral Hemorrhage

A cerebral hemorrhage is a bleed into the substance of the cerebrum . All cerebral hematomas, whatever the cause, have a similar resolution pattern on CT. The rate of resolution depends on the size of the hematoma, usually within one to six weeks, and they resorb from the outside toward the center. Accumulation of blood occurs over minutes or hours and the neurologic symptoms usually increase gradually over minutes or a few hours.Lobar intracerebral hemorrhage is bleeding in the largest part of the brain called the cerebrum. ICH has a mortality rate of 44 percent after 30 days, higher than ischemic stroke or even the very deadly subarachnoid hemorrhage (Liebeskind, 2004). The end result of a hematoma is decreased parenchymal density, focal atrophy and local ventricular dilatation.

With hemorrhage into the cerebral hemisphere, consciousness is initially lost or impaired in about one-half of patients. Vomiting occurs very frequently at the onset of bleeding, and headache is sometimes present. Focal symptoms and signs then develop, depending on the site of the hemorrhage. With hypertensive hemorrhage, there is generally a rapidly evolving neurologic deficit with hemiplegia or hemiparesis. A hemisensory disturbance is also present with more deeply placed lesions. With lesions of the putamen, loss of conjugate lateral gaze may be conspicuous. With thalamic hemorrhage, there may be a loss of upward gaze, downward or skew deviation of the eyes, lateral gaze palsies, and pupillary inequalities.

Cerebellar hemorrhage may present with sudden onset of nausea and vomiting, disequilibrium, headache, and loss of consciousness that may terminate fatally within 48 hours. Less commonly, the onset is gradual and the course episodic or slowly progressive—clinical features suggesting an expanding cerebellar lesion. In yet other cases, however, the onset and course are intermediate, and examination shows lateral conjugate gaze palsies to the side of the lesion; small reactive pupils; contralateral hemiplegia; peripheral facial weakness; ataxia of gait, limbs, or trunk; periodic respiration; or some combination of these findings.

The rate of resolution depends on the size of the hematoma, usually within one to six weeks, and they resorb from the outside toward the center. Diabetes and psychiatric morbidity were associated with nonlobar PICH. Smoking doubled the risk for lobar PICH, but was unrelated to nonlobar PICH. The bleeding is directly into the brain, forming a localized hematoma that spreads along white matter pathways The limited number of randomized controlled studies of treatment of ICH severely limit strong, positive recommendations for any intervention. Thus, these guidelines should be viewed as a basis for the development of future clinical trials, which are desperately needed.

Causes of Intracerebral Hemorrhage

Here are the list of the possible causes of Intracerebral Hemorrhage :

• Various blood or bleeding disorders , such as disseminated intravascular coagulation , hemophilia , sickle cell anemia , and leukemia.
• Decreased levels of blood platelets
• Use of aspirin or anticoagulant medications (blood thinners)
• Liver disease (associated with increased bleeding risk)
• Intracerebral hemorrhage can be caused by head injury (trauma), bleeding into a tumor, abnormalities of the blood vessels or an abnormality in blood clotting.

Symptoms of Intracerebral Hemorrhage

Some sign and aymptoms related to Intracerebral Hemorrhage:

• Dementia before the bleed occurs (rare in children) from cerebral amyloid
• Often described as occurring without nausea
• Sudden onset of difficulty with speaking, such as slurred or garbled speech
• Blurred or double vision or unequal pupils
• May increase with bending, straining, and coughing
• Sudden decrease in the level of consciousness
• Sleepy , lethargic , somnolent, stuporous

Treatment of Intracerebral Hemorrhage

Neurologic management is generally conservative and supportive, regardless of whether the patient has a profound deficit with associated brain stem compression, in which case the prognosis is grim, or a more localized deficit not causing increased intracranial pressure or brain stem involvement. Decompression is helpful, however, when a superficial hematoma in cerebral white matter is exerting a mass effect and causing incipient herniation. In patients with cerebellar hemorrhage, prompt surgical evacuation of the hematoma is appropriate, because spontaneous unpredictable deterioration may otherwise lead to a fatal outcome and because operative treatment may lead to complete resolution of the clinical deficit. The treatment of underlying structural lesions or bleeding disorders depends upon their nature.

• Treatment may include lifesaving measures such as medical hyperventilation, which involves inserting a breathing tube and forcing the the person to breathe rapidly to reduce pressure in the brain.
• Surgery may be done to repair or remove structures causing the bleed (such as a cerebral aneurysm or arteriovenous malformation ).
• Surgical repair of structures causing the bleed, such as repair of an aneurysm or 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.

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