Intracranial Hemorrhage, Cerebral Hemorrhage, & Hemorrhagic Stroke

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What are intracranial hemorrhage, cerebral hemorrhage, and hemorrhagic stroke?

An intracranial hemorrhage is a type of bleeding that occurs inside the skull (cranium).

Bleeding around or within the brain itself is known as a cerebral hemorrhage (or intracerebral hemorrhage). Bleeding caused by a blood vessel in the brain that has leaked or ruptured (torn) is called a hemorrhagic stroke. (All bleeding within the skull is referred to as intracranial hemorrhage.)

Hemorrhages that occur within the skull or brain generally happen suddenly, from either external or internal causes. A hemorrhage can rapidly cause brain damage and can be life-threatening.

Since the brain cannot store oxygen, it relies upon a series of blood vessels to supply oxygen and nutrients. The pooling of blood from an intracranial hemorrhage or cerebral hemorrhage puts pressure on the brain and deprives it of oxygen.

When a hemorrhage or stroke interrupts blood flow around or inside the brain, depriving it of oxygen for more than three or four minutes, the brain cells die. Furthermore, the affected nerve cells and the related functions they control are damaged.

Who is affected by intracranial hemorrhage?

Stroke is the leading cause of disability and the fourth-leading cause of death in the United States. Intracranial hemorrhage accounts for approximately 10% of all strokes in the United States.

Intracranial hemorrhage can strike people of any age, depending upon the cause. Although cerebral hemorrhage and hemorrhagic stroke are most commonly associated with older adults, they can also occur in children (pediatric stroke).

What are the causes of intracranial hemorrhage?

Intracranial hemorrhage has a number of causes, including:

  • Head trauma, such as that caused by a fall, car accident, sports accident, etc.
  • Hypertensive (high blood pressure) damage to blood vessel walls that causes the blood vessel to leak or break
  • Blockage of an artery in the brain by a blood clot that formed in the brain or traveled to the brain from another part of the body, with subsequent leakage from the damaged artery
  • Ruptured cerebral aneurysm (a weak spot in a blood vessel wall that balloons out and bursts)
  • Buildup of amyloid protein within the artery walls of the brain (cerebral amyloid angiopathy)
  • Leaking of malformed arteries or veins (arteriovenous malformation)
  • Treatment with anticoagulant therapy (blood thinners)
  • Bleeding tumors
  • Smoking, excessive alcohol use, or use of illegal drugs such as cocaine
  • Conditions related to pregnancy or childbirth, including eclampsia, postpartum vas culopathy, or neonatal intraventricular hemorrhage

What are the symptoms of intracranial hemorrhage?

  • Sudden tingling, weakness, numbness, or paralysis of the face, arm or leg, particularly on one side of the body
  • Sudden, severe headache
  • Difficulty with swallowing or vision
  • Loss of balance or coordination
  • Difficulty understanding, speaking (slurring nonsensical speech), reading, or writing
  • Change in level of consciousness or alertness, marked by stupor, lethargy, sleepiness, or coma

What are the effects of intracranial hemorrhage?

Besides depriving the brain of oxygen and killing brain cells, bleeding inside the brain also prevents nerve cells from communicating with the parts of the body and the functions they control. This results in a loss of memory, speech, or movement in the affected area.

Depending on the location of the hemorrhage and the extent of damage, the lasting effects of the intracranial hemorrhage can include:

  • Inability to move part of the body (paralysis)
  • Numbness or weakness in part of the body
  • Difficulty swallowing
  • Vision loss
  • Inability to speak or understand words (difficulty with communicating or comprehension)
  • Confusion, memory loss, or poor judgment
  • Personality change and/or emotional problems

How is intracranial hemorrhage diagnosed?

Diagnosis generally includes:

  • Evaluation of physical symptoms
  • A CT scan of the brain to determine if bleeding is present
  • An MRI to more clearly reveal the cause of bleeding

Other tests may include:

  • Electrocardiogram, chest X-ray, and/or urinalysis
  • Complete vascular study, complete blood count (CBC), and/or blood studies
  • Cerebrospinal fluid exam
  • In some cases, conventional angiography may be done to identify an aneurysm or arteriovenous malformation (irregularly formed arteries or veins)

How is intracranial hemorrhage treated?

Any type of bleeding inside the skull or brain is a medical emergency. It is important to get the person to a hospital emergency room immediately to determine the cause of the bleeding and begin medical treatment.

If a stroke has occurred, the cause (bleeding or blood clot) must be determined so that the appropriate treatment can be started. Prompt medical treatment can minimize damage to the brain, thereby improving the patient's chance of recovery.

Surgery may be necessary in the following situations:

  • Hemorrhage caused by a torn artery requires immediate decompression of the brain to release pooled blood and repair damaged blood vessels. Decompression may be done through a burr hole procedure, a craniectomy incision, or a craniotomy (opening of the skull cavity).
  • Hemorrhage caused by a ruptured cerebral aneurysm requires clipping of the aneurysm through a craniotomy surgical procedure, as soon as the patient's neurological condition permits.

Other treatments may include:

  • Anti-anxiety drugs and/or medication to control blood pressure
  • Anti-epileptic drugs for seizure control
  • Other medications necessary to control other symptoms, such as painkillers for severe headache and stool softeners to prevent constipation and straining during bowel movements
  • Nutrients and fluids as necessary. These may be given through a vein (intravenously), or a feeding tube in the stomach (gastronomy tube), especially if the patient has difficulty swallowing

What does long-term treatment include?

The goals of long-term treatment are to help the patient regain the functions necessary for daily living, as much and as soon as possible, and to prevent future intracranial hemorrhages. Rehabilitation and recovery time vary according to each individual's condition and the extent of rehabilitation possible.

Long-term rehabilitation treatment may include:

  • Physical therapy
  • Speech therapy, or alternative forms of communication
  • Occupational therapy
  • Lifestyle changes to reduce risk of another hemorrhage

What is the outlook (prognosis) for the patient following an intracranial hemorrhage, cerebral hemorrhage, or hemorrhagic stroke?

A patient who remains in a coma or has been severely paralyzed after an intracranial or cerebral hemorrhage may need long-term nursing home care.

For patients who regain consciousness after the initial episode, rehabilitative therapy may lead to substantial recovery, particularly in patients whose general health is otherwise good.

References:

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/4/2013…#14480

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