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| {{Infobox_Disease |
| | #redirect:[[Intracranial hemorrhage]] |
| Name = {{PAGENAME}} |
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| Image = |
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| Caption = |
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| DiseasesDB = 29320 |
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| ICD10 = {{ICD10|I|60||i|60}}-{{ICD10|I|62||i|60}} |
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| ICD9 = {{ICD9|430}}–{{ICD9|431}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = D002543 |
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| }}
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| {{SI}}
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| {{CMG}}
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| ==Overview==
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| A '''intracranial hemorrhage''' is a [[Bleeding|bleed]] into the substance of the [[cerebrum]].[http://www.emedicine.com/asp/dictionary.asp?keyword=cerebral+hemorrhage] Cerebral hemorrhages can lead to [[hemorrhagic stroke]]s and are medical emergencies
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| or '''hemorrhagic stroke''' is a form of [[stroke]] that occurs when a [[blood vessel]] in the [[human brain|brain]] ruptures or bleeds. Hemorrhagic strokes are deadlier than their more common counterpart, [[ischemic stroke]]s. Like ischemic strokes, hemorrhagic strokes interrupt the brain's [[blood]] supply, but in addition, blood irritates brain tissue, disrupting the delicate chemical balance, and, if the bleeding continues, the increased [[intracranial pressure]] can crush brain tissue and restrict blood flow into the brain (NINDS 1999). -->
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| Intracranial hemorrhages can result from
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| *[[epidural hemorrhage]]
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| *[[subdural hemorrhage]]
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| *[[subarachnoid hemorrhage]] and
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| *[[intracerebral hemorrhage]].
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| ==Intracerebral hemorrhage==
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| [[Intracerebral hemorrhage]], or ICH, accounts for 10 to 15 percent of all strokes (Weibers 2001). It most frequently results from high blood pressure as found in people with [[hypertension]], [[eclampsia]], and [[drug abuse|abuse of some drugs]] (Liebeskind, 2004). A third of intracerebral bleeds result in intraventricular haemorrhage, or bleeding within the brain's [[ventricular system|ventricles]] (Liebeskind, 2004). ICH has a mortality rate of 44 percent after 30 days, higher than ischemic stroke or even the very deadly [[subarachnoid hemorrhage]] (Liebeskind, 2004). The symptoms of intracerebral hemorrhage include a headache, nausea and vomiting, alertness changes, deficiencies in verbal skills, balance, swallowing, coordination, and focusing the eyes.
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| ==Subarachnoid hemorrhage==
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| [[Subarachnoid hemorrhage]], which accounts for 5 to 10 percent of strokes, is one of the deadliest type of strokes. While ischemic strokes have a 30-day mortality rate of 20 percent, subarachnoid bleeds kill 40% of their victims in the same time, disabling half the survivors. When a vessel in the [[arachnoid mater|arachnoid]] layer of the [[meninges]] bursts, blood enters the [[subarachnoid space]] where [[cerebrospinal fluid]] (CSF) bathes the brain, contaminating it. Since the brain is quite sensitive to changes in [[pH]], extensive damage can result when the chemical balance of the CSF is disturbed by the blood.
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| ==Symptoms of cerebral hemorrhage==
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| A sudden, severe headache is common in hemorrhagic stroke, and is especially indicative of that if accompanied by stiff neck, facial pain, pain between the eyes, vomiting, or altered consciousness (Weibers, 2001). Other signs of hemorrhagic stroke include those that indicate increased [[intracranial pressure]], caused by swelling or collection of blood. These include increased [[blood pressure]], unequal pupils, especially when one pupil is dilated and does not react to light, [[headache]], [[vomiting]], visual disturbances, and [[abnormal posturing|decorticate or decerebrate posturing]] (Yamamoto, 1996).
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| ==Pathophysiology==
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| Blood carries [[Blood plasma|plasma]] [[protein]]s, [[leukocyte]]s and other molecules which damage brain cells when they flood the area. Also, a rise in [[intracranial pressure]] exacerbates ischemia by compressing blood vessels and requiring higher blood pressures to force blood into tissues. A positive feedback loop is created: [[Hypoxia (medical)|hypoxic]] tissue swells, and swelling tissue becomes hypoxic .
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| ==Treatment==
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| Due to their life-threatening nature, cerebral hemorrhages require immediate neurosurgical evaluation and intervention. Neurosurgeons use specialized examinations for cerebral hemorrhage patients, such as the [[Hunt and Hess scale]], that can help determine the appropriate treatment. Strategies to protect the brain during this type of stroke include [[glycemia|blood sugar]] and blood pressure control, adequate oxygen and intravenous fluids, detection and treatment of the cause of bleeding, and constant monitoring (usually with the [[Glasgow Coma Scale]]) and immediate treatment for complications from bleeding into or around the brain.
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| Cerebral arteriography may be used to determine the cause for bleeding, since some causes may be surgically corrected to reduce the risk of future bleeding. Selected patients with subarachnoid hemorrhage due to a ruptured [[Cerebral aneurysm|aneurysm]] require emergency surgery to "clip" the aneurysm off from the normal brain blood circulation, and they receive [[nimodipine]], a drug shown to reduce incidence of [[vasospasm]], a complication of this type of stroke.
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| ==Risk factors==
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| Like ischemic stroke, risk factors for hemorrhagic stroke include [[myocarditis|inflammation of the heart]], [[hypertension]], and [[arteritis]]. [[Atherosclerosis]], the main risk factor for ischemic stroke (Cicala 1999), also causes [[heart disease]] and arterial rupture, so the presence of arterial fatty deposits is a major risk factor for hemorrhagic stroke as well. Factors that pose a risk for hemorrhagic stroke and not ischemic stroke include [[anticoagulant]] or [[thrombolytic]] therapy, [[bleeding disorder]]s like [[hemophilia]] and [[thrombocytopenic purpura]], [[arterial dissection]], and [[cocaine]] use (Weibers 2001).
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| Intracerebral hemorrhages may be caused by burst [[aneurysm]]s or [[arteriovenous malformation]]s, but are most often caused by hypertension, which can cause the delicate blood vessels in the brain to burst.
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| [[Aneurysm]], a weakening and ballooning in the wall of one of the brain's [[artery|arteries]], causes 75-90% of subarachnoid bleeds (Weibers, 2001). Aneurysms may put pressure on the brain tissue, but the real trouble occurs when the weakened wall bursts. The area near the [[Circle of Willis]] is a common spot for aneurysms: Small branches off the [[middle cerebral artery]] are so prone to burst that they are commonly known as "stroke arteries".
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| Vascular malformations such as [[arteriovenous malformation]] (AVM) are another cause of hemorrhagic stroke. AVM is a congenital condition that consists of a tangle of deformed blood vessels and [[capillary|capillaries]] with thin walls that can rupture (These malformations can cause subarachnoid hemorrhage but more commonly responsible for intracerebral bleeding (Weibers 2001). Vascular malformations and aneurysms usually cause no symptoms and can lie undetected until they cause a stroke. On occasion, they can cause "warning leaks" without actually bursting, causing symptoms like [[seizure]], [[migraine]], or [[hemiparesis|one-sided numbness]]
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| In [[moyamoya disease]], small blood vessels in a network replace normal blood vessels around base of brain because of stenosis or blockage of large arteries surrounding the brain These blood vessels are delicate and more likely than normal blood vessels to break and cause hemorrhagic stroke.
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| Unfortunately, some treatments for ischemic stroke aimed at dissolving the occluding blood clot can increase the likelihood of cerebral hemorrhage. Hemorrhagic transformation is the phenomenon in which blood vessels weakened by ischemic stroke rupture to cause hemorrhage in addition (Hemorrhagic transformation can occur without antithrombotics, but they increase the risk (Jauch, 2003).
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| For poorly understood reasons, pregnancy increases hemorrhagic stroke risk, and women who have just given birth are more than 28 times more likely to suffer hemorrhagic strokes than the average person.
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| ==Epidemiology==
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| Though ischemic strokes are more common, the young, though only a small percentage of stroke sufferers, are more likely to have hemorrhagic strokes than ischemic strokes (NINDS 1999).
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| ==References==
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| # Cicala, Roger. ''The Brain Disorders Sourcebook''. Los Angeles, CA: Lowell House, 1999. Electronic reproduction. Boulder, Colo.: NetLibrary, 2000. | |
| # Jauch, Edward C. 2005. [http://www.emedicine.com/neuro/topic9.htm “Acute Stroke Management.”] eMedicine.com, Inc. Available.
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| # Kapitt W and Lawrence M. The Anatomy Coloring Book. New York, NY: Harper & Row, 1977.
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| # Liebeskind, 2004. [http://www.emedicine.com/neuro/topic177.htm Intracranial Hemorrhage]. Emedicine.com. Available.
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| # National Institute of Neurological Disorders and Stroke (NINDS). National Institutes of Health., [http://www.ninds.nih.gov/disorders/stroke/detail_stroke.htm Stroke: Hope Through Research]. June 1999. Available.
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| # Nurse-Anesthesia.com. 2002.
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| # [http://www.strokecenter.org/education/ais_pathogenesis/ Stroke Center]. 1997-2003. Available.
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| # Weibers, D. ''Stroke-Free for Life: The Complete Guide to Stroke Prevention and Treatment''. Harper Collins, New York NY, 2001.
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| # Yamamoto, LG. 1996. [http://www.hawaii.edu/medicine/pediatrics/pemxray/v5c06.html “Intracranial Hypertension and Brain Herniation Syndromes: Radiology Cases in Pediatric Emergency Medicine"] Volume 5, Case 6. Kapiolani Medical Center for Women and Children; University of Hawaii; John A. Burns School of Medicine. Available.
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| ==External links==
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| *[http://www.csmc.edu/2424.html Cerebral hemorrhage] - Cedars-Sinai Health System.
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| *[http://www.wrongdiagnosis.com/c/cerebral_hemorrhage/stats.htm The statistics of cerebral hemorrhage] - Wrongdiagnosis.com
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| {{Cerebral hemorrhage}}
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| [[Category:Neurology]]
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| [[Category:Medical emergencies]]
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| [[Category:Cardiovascular diseases]]
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| [[Category:Emergency medicine]]
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| [[Category:Neurosurgery]]
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| [[Category:Cardiology]]
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| [[Category:Needs patient information]]
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| {{Link FA|he}}
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| [[da:Hjerneblødning]]
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| [[de:Hirnblutung]]
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| [[fa:خونریزی مغزی]]
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| [[fr:Hémorragie intra-cérébrale]]
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| [[ko:뇌출혈]]
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| [[it:Emorragia cerebrale]]
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| [[he:דימום תוך-גולגולתי]]
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| [[nl:Hersenbloeding]]
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| [[ja:脳出血]]
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| [[no:Hemorrhagisk hjerneslag]]
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| [[pt:Acidente vascular cerebral]]
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| [[fi:Aivoverenvuoto]]
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| [[sv:Hjärnblödning]]
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| [[zh:脑出血]]
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