Deep intracerebral hemorrhage
Definition
Deep intracerebral hemorrhage is a type of stroke due to bleeding within the deep structures of the brain. These structures include the thalamus, basal ganglia, pons, and cerebellum.
See also:
Alternative Names
Intracranial bleed
Causes
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:
- Angioma (a type of blood vessel tumor)
- Bleeding into a tumor
- Blood vessels problems (such as a cerebral aneurysm or arteriovenous malformation)
- Blood clotting problems
- Head injury (trauma)
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 swelling and a mass of blood within the brain put increasing pressure on the brain tissues and eventually destroy them.
Risk factors for deep intracerebral hemorrhage include:
- Certain blood or bleeding disorders
- Decreased blood platelets
- Disseminated intravascular coagulation (DIC)
- Hemophilia
- Leukemia
- Sickle cell anemia
- High blood pressure
- Liver disease
- Use of aspirin or blood thinners
Symptoms
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. Symptoms may include:
- Change in alertness (level of consciousness)
- Apathetic
- Coma
- Lethargy
- Sleepiness
- Stupor
- Unconsciousness
- Withdrawn
- Difficulty speaking or understanding others
- Difficulty swallowing
- Difficulty writing or reading
- Headache
- Occurs when lying flat
- Wakes you up from sleep
- Gets worse when you change positions or when you bend, strain, or cough
- Starts suddenly
- Loss of coordination
- Loss of balance
- Movement changes, usually on only one side of the body
- Difficulty moving any body part
- Loss of fine motor skills
- Nausea or vomiting
- Seizure
- Sensation changes, usually on only one side of the body
- Weakness of any body part
- Vision changes
- Decreased vision
- Loss of all or part of vision
Exams and Tests
A neurological exam may suggest increased intracranial pressure or decreased brain function. 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 brain.
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:
- Angiogram of the head
- Complete blood count (CBC)
- Bleeding time
- Blood clotting tests (Prothrombin time or partial thromboplastin time)
- Head CT (may be preferred if bleed is less than 48 hours old)
- Liver function tests
- Kidney function tests
- MRI of head
- Platelet count
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 back part of the brain called 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:
- Anticonvulsants to control seizures
- Corticosteroids or diuretics to reduce swelling
- Painkillers
Other treatments may be recommended, depending on your overall health and symptoms.
Outlook (Prognosis)
The outlook depends on the size of the hematoma and the amount of brain 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.
Possible Complications
- Fluid build-up in the brain (hydrocephalus)
- Permanent loss of any brain function, which may include:
- Loss of cognitive function
- Loss of movement of arm(s) or leg(s)
- Inability to eat or swallow
- Inability to speak
- Vision loss
- Side effects of medications used to treat the disorder
- Surgery complications
When to Contact a Medical Professional
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:
- Difficulty breathing
- Loss of ability to move or swallow
- Loss of consciousness
- Seizures
- Sudden loss of sensations
- Sudden change in mental state
Call your health care provider if severe headache with nausea, vomiting, decreased vision, numbness, or tingling occurs.
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), you will need to have regular blood tests to make sure that the medicines aren't making bleeding too likely and increasing your risk for hemorrhaging. Follow your doctor's instructions on how to take the medicine and when to have blood tests for monitoring the medication.
References
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.
Reviewed 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.
