An intracerebral hemorrhage (ICH) is bleeding in the brain tissue caused by the rupture of a blood vessel within the head.

• High blood pressure: chronic arterial hypertension
• Abnormalities of the blood vessels: arteriovenous malformations, amyloid angiopathy etc.
• Hemorrhage into a stroke
• Certain tumors
• Bleeding disorders (i.e. patients with hereditary bleeding abnormalities or patients on blood thinners)
• Traumatic brain injury
• Drug abuse (cocaine, alcohol, methamphetamines etc.)

• Bleeding disorders
• Use of blood thinners or aspirin
• Brain tumors
• Liver disease
• Previous stroke
• Seizures

ICH can manifest with a wide spectrum of symptoms depending on the location of the bleed and the size of the hematoma. Most ICH develop suddenly. Less frequently they develop in a stepwise, episodic manner, or they may get progressively worse.

• Abrupt onset of headache
• Increased intracranial pressure
• Nausea
• Vomiting
• Difficulty swallowing
• Difficulty speaking
• Dizziness
• Changes in vision
• Abnormal reflexes
• Inability to feel sensations properly
• Lack of balance
• Loss in coordination
• Confusion
• Seizure
• Decreased level of consciousness
• Stupor
• Coma

• Thorough history and physical examination
• Baseline laboratory studies
• CT scan of the brain
• Head MRI scan
• Cerebal angiography if indicated

Treatment depends on the location, cause, and extent of the hemorrhage.

• Medication to control blood pressure, reduce swelling and control seizures
• Reduction of intracranial pressure
• Surgery