INTRACEREBRAL HE...

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Definition

An intracerebral hemorrhage is bleeding in the brain caused by the breaking (rupture) of a blood vessel in the head. See also: Hemorrhagic stroke

Alternative Names

Intracranial hemorrhage; Hemorrhage - intracerebral; Hypertensive hemorrhage; Hemorrhagic cerebrovascular disease

Causes, incidence, and risk factors

Internal bleeding can occur in any part of the brain. Blood may build up in the brain tissues, or in the space between the brain and the membranes that cover it.

The bleeding may only be in one hemisphere (lobar intracerebral hemorrhage). Or it may occur in other brain structures, such as the thalamus, basal ganglia, pons, or cerebellum (deep intracerebral hemorrhage).

An intracerebral hemorrhage can be caused by:

• Abnormalities of the blood vessels (aneurysm or vascular malformation)
• High blood pressure (hypertensive intracerebral hemorrhage)
• Protein deposits along blood vessels (amyloid angiopathy)
• Traumatic brain injury

In some cases, no cause can be found.

Blood irritates the brain tissues, causing swelling (cerebral edema). It can collect into a mass called a hematoma. Either swelling or a hematoma will increase pressure on nearby brain tissues and can quickly destroy them.

Other factors that raise the risk of intracerebral hemorrhage include the following:

• Blood and bleeding disorders
  • Decreased levels of blood platelets
  • Disseminated intravascular coagulation
  • Hemophilia
  • Leukemia
  • Sickle cell anemia
• Cerebral amyloid or brain tumors
• Liver disease (associated with increased bleeding risk in general)
• Use of aspirin or blood thinners (anticoagulant medications, such as warfarin)

Premature infants (born earlier than 35 weeks) will sometimes have bleeding into the fluid-filled spaces (ventricles) in the brain. This type of bleed is called intra-ventricular hemorrhage (IVH). This occurs in the first day or so of life and is usually not preventable.

Reviewer Info: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., 09/25/2008