Health Encyclopedia

Hypertensive intracerebral hemorrhage

Definition

Hypertensive intracerebral hemorrhage is type of stroke in which there is bleeding in the brain due to high blood pressure.

Causes, incidence, and risk factors

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

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:

Decreased consciousness
- Comatose
- Lethargic
- Sleepy
- Stuporous
- Unconscious
- Withdrawn
Difficulty reading or writing
Difficulty speaking or understanding others
Difficulty swallowing
Headache
- Gets worse when you change position, such as bending, straining, or coughing
- May wake you up from sleep
- Occurs when lying flat
Loss of coordination
Loss of balance
Movement changes
- Difficulty moving any body part
- Loss of fine motor skills
Nausea or vomiting
Seizure
Sensation changes
Weakness of any body part
Vision changes
- Any change in vision
- Decreased vision
- Loss of vision off to one side

Signs and tests

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:

CBC
Platelet count
Bleeding time
Prothrombin time
Partial thromboplastin time
Liver function tests
Kidney function tests
Angiography of the head (if symptoms allow enough time to perform this test) -- reveals any aneurysm or arteriovenous malformation present

However, an image of the brain is needed to prove the condition is due to intracerebral hemorrhage. This can be done with a:

Head CT scan (preferred if the hemorrhage began less than 48 hours earlier)
Head MRI

Treatment

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:

Anticonvulsants to control seizures
Corticosteroids or diuretics to reduce swelling
Medications to control blood pressure
Painkillers

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.

Expectations (prognosis)

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.

Complications

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
Seizures
Side effects of medications used to treat the disorder
Surgery complications

Calling your health care provider

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 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

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.

Review Date:9/13/2008
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.

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