Hypertensive intracerebral hemorrhage

Definition

Hypertensive intracerebral hemorrhage is type of stroke involving bleeding in the brain caused by high blood pressure. See also:

• Hemorrhagic stroke

Causes

Intracerebral hemorrhage can affect anybody, but it is most common in older people.

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. Constant, high blood pressure wears away at the vessel walls and can lead to blockage of the vessels and 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.

However, even in patients without known high blood pressure, cocaine use can cause intracerebral hemorrhages.

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, often during activity. There is a rapid loss of function(s) on one side of the body.

The symptoms can be the same as those that result from too little blood flow to the brain (stroke), and may include:

• Vision changes
  • Any change in vision
  • Loss of vision off to one side
  • Decreased vision
• Sensation changes
  • Numbness, tingling
  • Decreased sensation
  • Abnormal sensations
• Movement changes
  • Weakness of any body part
  • Difficulty moving any body part
  • Loss of fine motor skills
• Difficulty speaking or understanding others
• Difficulty swallowing
• Difficulty reading or writing
• Loss of coordination
• Loss of balance
• Seizure
• Headache
  • When lying flat
  • May awaken from sleep
  • Increases with change in position, bending, straining, coughing
• Nausea, vomiting
• Decreased consciousness
  • Apathetic, withdrawn
  • Sleepy, lethargic, somnolent, stuporous
  • Unconscious, comatose

Exams 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

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.

Medications include:

• Anti-hypertensive medications to control blood pressure
• Corticosteroids such as hydrocortisone and diuretics to drain fluid from the body to reduce brain swelling
• Anti-convulsants to control seizures
• Analgesics to control pain

If the patient gets quick medical attention, anti-bleeding therapy may be appropriate. This involves using a medicine that stops the bleeding. It is very important that this type of medicine be given within 3 hours of the symptoms first starting, so it is important to get to the hospital quickly. Such therapy is still being studied, and there are strict guidelines regarding who should and should not get such medication. There is a risk of significant side effects with anti-bleeding therapy.

Most patients will be admitted to a hospital's intensive care unit (ICU) for close monitoring.

Outlook (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.

Possible Complications

• Permanent loss of any brain function
• Seizures
• Side effects of medications and treatments
• Complications of surgery

When to Contact a Medical Professional

Intracerebral hemorrhage is a life-threatening condition requiring immediate emergency medical attention.

Go to the emergency room or call the local emergency number (such as 911) if symptoms of hypertensive intracerebral hemorrhage occur. Emergency symptoms include difficulty breathing, seizures, loss of consciousness, inability to speak and swallowing difficulties, numbness or clumsiness on one side of the body, slurred speech, or confusion.

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 advised to do so by your health care provider!

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