Etiology, pathology and prognosis of intracerebral hemorrhage

1. Big picture

Intracerebral hemorrhage, ICH, means bleeding directly into the brain parenchyma. It is one of the most severe forms of stroke because the hematoma causes damage in two ways:

1. Direct tissue destruction by blood

2. Mass effect, edema, raised intracranial pressure, ventricular compression, and herniation

The most important exam message:

Hypertension is the most important cause of spontaneous deep intracerebral hemorrhage.

The second very important cause, especially in elderly patients with lobar hemorrhage, is:

Cerebral amyloid angiopathy.

ICH usually has a more severe clinical picture than ischemic stroke: headache, vomiting, hypertension, rapid neurological worsening, seizures, and impaired consciousness are more common.

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