Intracerebral Hemorrhage

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Overview, Causes, & Risk Factors

Internal bleeding can occur in any part of the brain. Blood may accumulate in the brain tissues or in the space between the brain and the membranes covering the brain (subarachnoid space). The bleeding may be isolated to part of one cerebral hemisphere (lobar intracerebral hemorrhage) or it may occur in other brain structures, such as the thalamus, basal ganglia, pons, or cerebellum (deep intracerebral hemorrhage).

Intracerebral hemorrhage can be caused by trauma (brain injury) or abnormalities of the blood vessels (aneurysm or angioma). When it is not caused by one of these conditions, it is most commonly associated with high blood pressure (hypertensive intracerebral hemorrhage). In some cases, no cause can be found.

Blood irritates the brain tissues, causing swelling (cerebral edema). It can collect into a mass called a hematoma. Both cerebral edema and the presence of a hematoma within the brain will put increasing pressure on brain tissues and can rapidly destroy them.

Symptoms vary depending on the location of the bleed and the amount of brain tissue affected. Symptoms usually develop suddenly, without warning, often during activity. They may occasionally develop in a stepwise, episodic manner or they may get progressively worse.

Other factors that raise the risk of intracerebral hemorrhage include the following:

• Blood and bleeding disorders
  • Disseminated intravascular coagulation
  • Hemophilia
  • Sickle cell anemia
  • Leukemia
  • Decreased levels of blood platelets
• Use of aspirin or anticoagulant medications (blood thinners)
• Liver disease (associated with increased bleeding risk in general)
• Cerebral amyloid or brain tumors

Premature infants (born earlier than 35 weeks gestation) will sometimes have bleeding into the ventricles (fluid-filled spaces) in the brain. This type of bleed is called intra-ventricular hemorrhage (IVH). This occurs in the first day or so of life and is usually not preventable. The outcome is variable, depending on the severity of bleed and ranges from no apparent damage to severe disability. Diagnosis is by ultrasound and usually done in an intensive care nursery.