A cerebral hemorrhage (or intracerebral hemorrhage, ICH), is a subtype of intracranial hemorrhage that occurs within the brain tissue itself. Intracerebral hemorrhage can be caused by brain trauma, or it can occur spontaneously in hemorrhagic stroke. Non-traumatic intracerebral haemorrhage is a spontaneous bleeding into the brain tissue.^[1]

A cerebral hemorrhage is an intra-axial hemorrhage; that is, it occurs within the brain tissue rather than outside of it. The other category of intracranial hemorrhage is extra-axial hemorrhage, such as epidural, subdural, and subarachnoid hematomas, which all occur within the skull but outside of the brain tissue. There are two main kinds of intra-axial hemorrhages: intraparenchymal hemorrhage and intraventricular hemorrhages. As with other types of hemorrhages within the skull, intraparenchymal bleeds are a serious medical emergency because they can increase intracranial pressure. The mortality rate for intraparenchymal bleeds is over 40%.^[2]

Causes

CT scan showing hemorrhage in the posterior fossa^[1]

Symptoms

Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed.^[6] Other symptoms include those that indicate a rise in intracranial pressure due to a large mass putting pressure on the brain.^[6] Intracerebral hemorrhages are often misdiagnosed as Subarachnoid hemorrhages due to the similarity in symptoms and signs.

Diagnosis

Spontaneous ICH with hydrocephalus on CT scan^[1]

Prognosis

The risk of death from an intraparenchymal bleed in traumatic brain injury is especially high when the injury occurs in the brain stem.^[2] Intraparenchymal bleeds within the medulla are almost always fatal, because they cause damage to cranial nerve X, the vagus nerve, which plays an important role in blood circulation and breathing.^[3] This kind of hemorrhage can also occur in the cortex or subcortical areas, usually in the frontal or temporal lobes when due to head injury, and sometimes in the cerebellum.^[3][7]

For spontaneous ICH seen on CT scan, the death rate (mortality) is 34?50% by 30 days after the insult.^[1]

References

External links

• Parent friendly information on IVH in premature babies from The Hospital for Sick Children
• LPCH on Intraventricular

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