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Definition Return to top
Hypertensive intracerebral hemorrhage is type of stroke in which there is bleeding in the brain due to high blood pressure.
Causes Return to top
Hypertensive intracerebral hemorrhage is caused by long-term high blood pressure (hypertension).
When blood pressure has remained high for a significant period of time, the walls of blood vessels change and become weak. Constant, high blood pressure wears away at the vessel walls and can lead to blockage of the vessels or leakage of blood into the brain. Blood irritates the brain tissues, causing swelling (cerebral edema). The blood collects into a mass called a hematoma.
Brain tissue swelling and a hematoma within the brain put increased pressure on the brain and can eventually destroy it.
Bleeding may occur in the hollow spaces (ventricles) in the center part of the brain or into the subarachnoid space (the space between the brain and the membranes that cover the brain). Such bleeding can cause symptoms of meningitis.
Use of cocaine, amphetamines, or other illicit stimulants can cause intracerebral hemorrhages in persons without high blood pressure.
Intracerebral hemorrhage can affect anybody, but it is most common in older people.
Symptoms Return to top
Symptoms depend on the location of the bleeding in the brain and how much damage has occurred. Symptoms most commonly develop suddenly, without warning, and often during activity. There is a rapid loss of function on one side of the body.
The symptoms can be the same as those that result from a stroke, and may include:
Exams and Tests Return to top
A neurological exam may show signs of increased pressure in the brain, such as swelling of the optic nerve or changes in eye movement. The doctor will check your reflexes and movement to see if there have been any changes in brain function.
Changes in function may help reveal the location of the problem within the brain.
In order to be classified as a hypertensive hemorrhage, the person must have some history of high blood pressure. Often the blood pressure is still very high when the patient is examined. Other tests may show other signs of high blood pressure, such as abnormal blood vessels in the eyes or problems with kidney function.
Tests to determine the amount and cause of bleeding include:
However, an image of the brain is needed to prove the condition is due to intracerebral hemorrhage. This can be done with a:
Treatment Return to top
Intracerebral hemorrhage is a severe condition that requires prompt medical attention. It can develop quickly into a life-threatening situation.
Surgery may be needed to remove the hematoma, especially if there is a hematoma in the base of the brain (cerebellum). If bleeding blocks the flow of spinal fluid, a shunt or drain in the brain may be recommended in some cases.
Medicines used may include:
Other treatments may be recommended, depending on your overall health and symptoms.
Most patients will be admitted to a hospital's intensive care unit (ICU) for close monitoring.
Outlook (Prognosis) Return to top
How well a person does depends on the size and location of the bleed. Recovery can occur completely, or there may be some level of permanent loss of brain function.
Medications, surgery, and other treatments can have severe side effects. Death can occur rapidly despite prompt medical attention.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
Any type of intracerebral hemorrhage, or "brain attack," is a medical emergency.
Go to the emergency room or call 911 if other symptoms of deep intracerebral hemorrhage develop. Emergency symptoms include:
Call your health care provider if severe headache with nausea, vomiting, decreased vision, numbness, or tingling occurs.
Prevention Return to top
Treatment and control of disorders that can bring on intracerebral hemorrhage will reduce the risk. High blood pressure should be treated as appropriate. Do not stop taking medications unless told to do so by your doctor.
References Return to top
Zivin JA. Hemorrhagic cerebrovascular disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 432.
Goldstein LB. Prevention and management of stroke. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders;2007:chap 58.Update Date: 9/13/2008 Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.