We have changed our visitation policy for the safety of our patients and staff. Click here for the updated visitation policy and click here for information about COVID-19.

Lahey Health is now part of Beth Israel Lahey Health

(ICH)

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