What is Intracerebral Hemorrhage?

An intracerebral hemorrhage (ICH) happens when a bleed originates within the functioning tissue of the brain or the brain parenchyma. ICH follows when blood suddenly bursts into brain tissue, causing brain damage. ICH is a medical emergency that involves immediate care. ICH symptoms usually emerge suddenly. ICH is less common, but it is more serious. An intracerebral hemorrhage is a potentially fatal stroke in which the brain is deprived of oxygen and blood.

Types of ICH

ICH can be characterized as primary or secondary based on the cause of the hemorrhage. Primary ICH happens suddenly or spontaneously, whereas secondary ICH is caused by underlying disorders.

Frequent aetiologies of primary and secondary ICH include:

  • If you have primary hypertension,
  • If you have cerebral amyloid angiopathy disorder,
  • If you face a secondary trauma problem,
  • If you are diagnosed with primary and secondary brain tumors,
  • If you have a problem with an abnormal knot of blood vessels connecting arteries and veins in the brain,
  • If you suffer from ballooning in a blood vessel in the brain,
  • If you develop a blood clot that blocks a blood vessel in your brain,


Intracerebral hemorrhage can be triggered by trauma (brain injury) or blood vessel irregularities (aneurysm or angioma), although it is most frequently related to hypertension. High BP is the most frequent cause of ICH.

Other reasons include:

  • Severe head injuries or trauma
  • If your doctor diagnoses a weak blood spot vessel that bursts
  • If you form a grouping of deformed blood vessels in your brain, that inhibits the standard blood spurt.
  • If you have bleeding tumors,
  • Overuse of Cocaine or methamphetamine can cause severe hypertension and lead to ICH.
  • If a patient has a bleeding disorder,
  • ICH can occur at any age, but the risk increases with age.

Symptoms and Signs

  • If you have persistent severe headaches,
  • You may have difficulty speaking.
  • If you have difficulty grasping others,
  • If you suddenly cannot write or read,
  • Tingling or weakness in one arm, leg, or side of the face may occur suddenly.
  • If you have dementia issues,
  • If you suffer from a loss of awareness,
  • If you have extreme fatigue,
  • Extreme nausea and vomiting
  • If you have a loss of balance problem,
  • If you have an issue with your eyes,
  • Misplacing coordination
  • If you suffer from apathy, you will experience sleepiness, lethargy, and a loss of consciousness.

Risk Factor

The risk of an intracerebral hemorrhage may increase as they age, especially as high BP is more frequent in older adults.

Modifiable risk factors

  • Hypertension
  • Chain-smoking habit
  • Heavy consumption of alcohol
  • Decreased Low triglycerides and low-density lipoprotein cholesterol can cause ICH.
  • Anticoagulation treatment can cause ICH.
  • Make use of the anti-platelet medication.
  • If a patient has a bleeding disorder,

Other risk factors that cannot be changed are as follows:

  • Growing age
  • Male sex can be a risk factor.
  • Cerebral amyloid angiopathy is a risk factor.
  • Cerebral microbleeds are another issue.
  • Chronic renal disease is a risky condition.

Diagnosis and Tests

You will need to undergo a neurological exam if you have symptoms of ICH. Imaging tests determine if you're having an ischemic stroke (blockage) or a hemorrhagic stroke (bleeding). Blood tests can help identify immune system disorders, inflammation, and blood clotting issues that may lead to brain bleeding.

  • A computed tomography, or CT scan test, creates images of your brain that confirm bleeding and assess other evidence of trauma to your head.
  • A brain MRI may enable your doctor to see your brain more clearly and identify the source of the bleeding more accurately.
  • Angiography uses an X-ray to determine the blood flow through an artery and any abnormalities within the blood vessels.

Treatment and Care:

A better prognosis is achieved by treating the patient within the first three hours of symptoms. Further treatment of the sufferer may avoid death. ICH is also known as hemorrhagic stroke or intraparenchymal hemorrhage.

There are two types of treatment for an intracerebral hemorrhage:

  1. Immediate treatment
  2. Long-term treatment

Surgery can reduce pressure on the brain and repair arteries that have ruptured. Specific drugs, such as pain relievers for severe headaches, might help manage symptoms.

BP regulation may necessitate the use of medications. In long-term care, a person may require a remedy to control high blood pressure and reduce the risk of future hemorrhages. Your neurosurgeon may offer additional treatment that depends on the damage to the brain. Physiotherapy may help the patient regain muscle control, which reduces their dependency on others. Depending on your symptoms, physical and speech therapy may help you restore muscular function and improve communication.

A Typical Test for ICH:

Radio scan Image tests can tell if you're suffering from an ischemic (blockage) or hemorrhagic (bleeding) stroke. A CT scan, a brain MRI, and angiography are all possible options.

Primary Prevention

Immediate medical or emergency medical treatment within the first three hours of the occurrence.

Primary prevention of stroke includes

  • Lifestyle modifications
  • Control high BP,
  • high cholesterol levels.
  • Diabetes mellitus and
  • The risk of ICH can be reduced by up to 45% with primary prevention.

Differential Diagnosis

Neurosurgeons carry an accurate differential diagnosis approach for intracerebral bleeding, and it predicts ischemic stroke, acute hypertensive crisis, sentinel headache, and hypoglycemia.


The total incidence of intracerebral hemorrhage (ICH) is 24.6 per 100,000 person-years and is linked to a high case fatality rate. The global incidence of ICH has remained constant, although the country-wise incidences vary by race, gender, season, and location.

Natural Progression

It can cause lifelong brain damage and death if not treated. A brain aneurysm is the most common cause of ICH. It might be caused by a problem with blood vessels or other health issues.


The rupture of small arteries within the brain tissue frequently causes an intracerebral hemorrhage (ICH). A hematoma, or blood clot, occurs as blood gathers, increasing pressure on the brain.


Hematoma enlargement, perihematomal edema with increased intracranial pressure, bleeding extension, and convulsions are all consequences of Intracerebral Hemorrhage.

Our Medical Intracerebral Hemorrhage Experts

If you are facing any similar signs or symptoms please contact the Nanavati Max team to schedule an appointment at : +91 22 6836 0000

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