Deep intracerebral hemorrhage

Definition

Deep intracerebral hemorrhage is a type of stroke caused by bleeding within the deep structures of the brain (thalamus, basal ganglia, pons, and cerebellum).

Alternative Names

Intracranial bleed

Causes, incidence, and risk factors

Deep intracerebral hemorrhage can affect any person regardless of age, sex, or race, though it is more common in older people. It may be caused by head injury (trauma), bleeding into a tumor, problems with blood vessels (such as a cerebral aneurysm or angioma) or blood clotting problems. In some cases, no cause can be found.

Bleeding in the brain irritates the brain tissues, causing swelling (cerebral edema). The blood may collect into a mass (hematoma). Both cerebral edema and the presence of a hematoma within the brain put increasing pressure on the brain tissues and eventually destroy them.

Risk factors for deep intracerebral hemorrhage include:

• Various blood or bleeding disorders
  • Disseminated intravascular coagulation (DIC)
  • Hemophilia
  • Sickle cell anemia
  • Leukemia
  • Decreased blood platelets
• Use of aspirin or anticoagulant medications (blood thinners)
• Liver disease (associated with increased bleeding risk)

See also:

Hypertensive intracerebral hemorrhage

Symptoms

• Headache, which may:
  • Occur when lying flat
  • Cause you to wake up
  • Increase when you change positions
  • Start suddenly
  • Increase when you bend, strain, or cough
• Nausea or vomiting
• Change in alertness (level of consciousness)
  • Apathetic, withdrawn
  • Sleepiness, lethargy, stupor
  • Unconsciousness, coma
• Decreased vision
• Loss of all or part of vision
• Sensation changes, usually on only one side of the body
  • Decreased sensation
  • Numbness or tingling
  • Abnormal sensations
• Difficulty speaking or understanding others
• Difficulty swallowing
• Difficulty writing or reading
• Movement changes, usually on only one side of the body
  • Weakness of any body part
  • Difficulty moving any body part
  • Loss of fine motor skills
• Loss of coordination
• Loss of balance
• Seizure

The symptoms vary depending on the location of the bleed and the amount of brain tissue affected. Symptoms most commonly develop suddenly, without warning, often during activity. They may be episodic (occurring and then stopping) or slowly get worse over time.

Signs and tests

A neurological exam may suggest increased intracranial pressure or decreased brain functions. The person's specific symptoms can help tell which part of the brain is affected. For example, sudden nausea, vomiting, loss of balance, headache, and a rapid decrease in consciousness can mean a bleed in the cerebellum or brainstem.

An eye exam may show swelling of the optic nerve from pressure in the brain, or there may be changes in eye movement. Abnormal reflexes may be present.

Tests may include:

• CBC
• Platelet count
• Bleeding time
• Prothrombin time (PT) or partial thromboplastin time (PTT)
• Liver function tests
• Kidney function tests
• Head CT (may be preferred if bleed is less than 48 hours old)
• MRI of head
• Angiogram

Treatment

Deep intracerebral hemorrhage is a severe condition that requires prompt medical attention. It can develop quickly into a life-threatening situation.

Treatment depends on the location, cause, and extent of the hemorrhage.

Surgery may be needed, especially if there is bleeding in the cerebellum. Surgery may also be done to repair or remove structures causing the bleed (such as a cerebral aneurysm or arteriovenous malformation).

Medicines used may include painkillers, corticosteroids or diuretics to reduce swelling, and anticonvulsants to control seizures. Other treatments may be recommended, depending on the condition of the person and the symptoms that develop.

Expectations (prognosis)

How well a patient does depends on the size of the hematoma and the amount of swelling.

Recovery may occur completely, or there may be some permanent loss of brain function. Death is possible, and may quickly occur despite prompt medical treatment.

Medications, surgery, or other treatments may have severe side effects.

Complications

• Permanent loss of any brain function
  • Loss of vision
  • Loss of movement of one or all extremities
  • Loss of speaking ability
  • Loss of eating or swallowing ability
  • Loss of cognitive function
• Complications of surgery
• Side effects of medications used to treat the disorder
• Hydrocephalus, especially if blood is in the ventricles.

Calling your health care provider

Call your health care provider if severe headache with nausea, vomiting, decreased vision, numbness, or tingling occurs.

Go to the emergency room or call 911 if other symptoms of deep intracerebral hemorrhage develop. Emergency symptoms include difficulty breathing, seizures, loss of ability to move or swallow, sudden loss of sensations, sudden change in mental state, and loss of consciousness.

Prevention

Treatment or control of underlying disorders may reduce the risk of developing intracerebral hemorrhage. High blood pressure should be treated. Do not stop taking medications unless told to do so by your doctor.

Always use safety equipment and take safety precautions in sports, recreation, and work. For example, use hard hats, bicycle or motorcycle helmets, and seat belts. Never dive into water if you do not know the depth of the water or if there may be rocks under the surface.

If you are taking a blood thinner (such as Coumadin), follow your doctor's instructions on how to take the medicine and when to have blood tests for monitoring the medication.