Neurosurgery: Intracerebral Hemorrhage (ICH)

Intracerebral Hemorrhage (ICH)

Definitions

  • Intracerebral Hemorrhage (ICH): Bleeding within the Brain Parenchyma
  • Types:
  • Second Most Common Cause of Stroke (Behind Ischemic Stroke)

Causes

  • Hypertensive Vasculopathy – Most Common Cause of Spontaneous ICH
    • Hemorrhaging Vessels Often Occur at Right Angles – No Protection from Gradual Decrease in Vessel Caliber Size
  • Cerebral Amyloid Angiopathy
  • Ruptured Saccular Aneurysm
    • Occurs at Branching Points
    • Most Common Site: Anterior Communicating Artery
    • Rupture Mortality Rate: 50%
  • Arteriovenous Malformation (AVM) – Most Common Cause in Peds
  • Less Common Causes:
    • Septic Embolism
    • Cerebral Venous Thrombosis
    • Brain Tumor
    • Cerebral Hyperperfusion Syndrome
    • Drug Abuse
    • Bleeding Diathesis

Presentation

  • Symptoms Often Progress Over Minutes-Hours
    • *Compared to Sudden Onset of Maximal Intensity with Embolism or Subarachnoid Hemorrhage
  • Altered Mental Status
  • Headache
  • Nausea & Vomiting
  • Seizures

Diagnosis

  • Primary Diagnosis: Imaging (CT or MRI)
  • May Need CTA/MRA to Determine Etiology Such as AVM or Aneurysm

Treatment

  • Definitive Management Depends on Pathology, Performance Status & Prognosis
  • Potential Managements:
    • Surgical Resection
    • Coil Embolization
    • Anticoagulant Reversal
    • Antihypertensives
    • Antiepileptic Treatment
  • Intracranial Pressure Management