Definition
An intracerebral hemorrhage (ICH) is bleeding in the brain. It is a type of stroke that can be deadly.
Causes
ICH is caused by a burst blood vessel in the brain. The most common causes are:
- High blood pressure
- Cerebral amyloid angiopathy—a buildup of a protein on the walls of the arteries in the brain
Other causes may be:
- Head trauma
- Abnormal blood vessels in the brain, such as cerebral aneurysms and arteriovenous malformations
- Bleeding disorders
- Medicine used to treat bleeding disorders
- Tumors
- Drug use, such as cocaine
Risk Factors
Older adults are at higher risk. It is also more common in men and people who are Black, Hispanic, Asian, and Native American. A family history of stroke also raises the risk.
Other things that may raise the risk are:
- Having certain health problems, such as high blood pressure, bleeding disorders, or diabetes
- Having abnormal blood vessels
- Taking blood thinning medicine
- Smoking
- Using drugs, such as cocaine
- Alcohol use disorder
Symptoms
Symptoms depend on the size and location of the ICH. A person may have:
- Sudden weakness or numbness of the face, arm, or leg, often on one side
- Sudden confusion
- Problems speaking
- Problems seeing in one or both eyes
- Loss of consciousness
- Nausea and vomiting
- Sudden severe headache
- Seizures
Diagnosis
The doctor will ask about your symptoms and health history. A physical exam will be done.
Blood tests and urine tests will be done.
Images will be taken of your brain. This can be done with:
- CT scan
- MRI scan
Treatment
Brain tissue can die without blood. Emergency care will be needed right away. It may include:
Medicine
Medicine may be given to:
- Help the blood clot
- Lower blood pressure
- Control seizures
Surgery
Surgery may be done on people with severe ICH to remove blood and ease pressure in the brain. This is not common.
Rehabilitation
Recovery depends on how much harm was done. It may include:
- Physical therapy to regain movement
- Occupational therapy to help with daily tasks and self-care
- Speech therapy to improve swallowing and talking
Prevention
These things can help lower the risk of getting ICH:
- Stop or limit alcohol. This means no more than 1 drink per day for women and no more than 2 drinks per day for men.
- Reach and stay at a healthy weight.
- Manage high blood pressure.
- Take steps to stop smoking.
RESOURCES
American Heart Association http://www.heart.org
National Stroke Association http://www.stroke.org
CANADIAN RESOURCES
Heart and Stroke Foundation http://www.heartandstroke.ca
Public Health Agency of Canada http://www.phac-aspc.gc.ca
References
Hemphill JC 3rd, Greenberg SM, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 Jul;46(7):2032-2060.
Intracranial hemorrhage, cerebral hemorrhage and hemorrhagic stroke. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/diseases/14480-intracranial-hemorrhage-cerebral-hemorrhage-and-hemorrhagic-stroke. Updated October 25, 2016. Accessed October 29, 2019.
Intracerebral hemorrhage. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/intracerebral-hemorrhage . Updated September 5, 2019. Accessed October 29, 2019.
Intracerebral hemorrhage (ICH). Mayfield Brain and Spine website. Available at: https://mayfieldclinic.com/pe-ich.htm. Updated April 2018. Accessed October 29, 2019.
Intracerebral hemorrhage. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/neurologic-disorders/stroke/intracerebral-hemorrhage?query=Intracerebral%20Hemorrhage. Updated February 2017. Accessed October 29, 2019.
Revision Information
- Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
- Review Date: 10/2019
- Update Date: 06/30/2020