Cerebral hemorrhage

Cerebral hemorrhage

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Cerebral hemorrhage

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
Symptoms
Diagnosis
Prognosis
References
External links

Causes

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

Intracerebral bleeds are the second most common cause of stroke, accounting for 30?60% of hospital admissions for stroke.^[1] High blood pressure raises the risk of spontaneous intracerebral hemorrhage by two to six times.^[1] More common in adults than in children, intraparenchymal bleeds due to trauma are usually due to penetrating head trauma, but can also be due to depressed skull fractures, acceleration-deceleration trauma,^[3]^[4]^[5] rupture of an aneurysm or arteriovenous malformation (AVM), and bleeding within a tumor. A very small proportion is due to cerebral venous sinus thrombosis.

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]

Intraparenchymal hemorrhage can be recognized on CT scans because blood appears brighter than other tissue and is separated from the inner table of the skull by brain tissue. The tissue surrounding a bleed is often less dense than the rest of the brain due to edema, and therefore shows up lighter on the CT scan.

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]