Your Health Matters

Intracerebral Hemorrhage (ICH)

Overview

Intracerebral hemorrhage happens when a diseased blood vessel inside the brain bursts, letting the blood leak inside the brain. (The name means within the cerebrum or brain). This problem is also called a hemorrhagic stroke. The sudden increase in pressure inside the brain can cause damage to the brain cells exposed to the blood. If the amount of blood increases too fast, the sudden buildup in pressure can lead to unconsciousness or death. Intracerebral hemorrhage usually happens in selected parts of the brain, including the basal ganglia, cerebellum, brain stem, or cortex. *The most common cause of intracerebral hemorrhage is high blood pressure. Since high blood pressure by itself often causes no symptoms, many people with intracranial hemorrhage are not aware that they have high blood pressure, or that it needs to be treated. Less common causes of intracerebral hemorrhage include trauma, infections, tumors, blood clotting deficiencies, drug abuse and abnormalities in blood vessels (such as an aneurysm or arteriovenous malformations AKA “AVM”).

Symptoms **Symptoms usually come on suddenly and can change depending on the location of the bleed. They may sometimes develop in a stepwise pattern, or they may get worse over time. Common symptoms include: • Sudden weakness or numbness of face, arm or leg; especially if the numbness is all on one side of the body • Sudden confusion, trouble speaking or understanding • Sudden trouble seeing in one or both eyes • Sudden trouble walking,PROOF dizziness, loss of balance or coordination • Sudden severe headache with no known cause

***Risk factors

• High blood pressure • Illegal drug use • Alcohol abuse • Bleeding disorders

SDNEU0089 • Revised 11/13 • Use of blood thinners or aspirin

Find a Doctor: (888) 689-8273 • Patient Education Library: www.ucsfhealth.org/education • Brain tumors • Liver disease • Previous stroke • Seizures • Trauma

Diagnosis To diagnose your condition, your doctor will need to perform a complete checkup including your medical history and a physical exam, get some initial laboratory studies and imaging of your brain. Several tests can be useful, including a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. An angiogram of the brain may be done to help see which blood vessels are involved. An angiogram is performed by the neuro-interventional radiology team and is usually done under anesthesia.

Treatment Treatment is based on the underlying cause of the intracranial hemorrhage. Medications will be used to manage blood pressure, control swelling in the brain, and symptom relief such as pain relievers for headache. If blood thinning medications were the cause of the hemorrhage, reversal medications to help the blood clot may be given. If a seizure occurred, anti-seizure medication will be given. Sometimes giving blood products are necessary also. Invasive procedures such as placement of an intracranial pressure monitoring device may be performed by the neurosurgery physician in the intensive care unit. This is called an external ventricular drain. This device allows the medical team to record the intracranial pressure in the brain. Also, it serves to drain excess cerebral spinal fluid and blood products that the brain cannot absorb on its own. Surgery may be necessary to remove a blood clot in the brain and stop the bleeding. It may be necessary to remove a portion of the skull and keep it off for some time in order to relieve pressure while the brain swells. This is called a craniectomy, or bone flap removal. If an aneurysm is the cause for the intracranial hemorrhage, the aneurysm may need to be surgically clipped or coiled by angiography. If an arteriovenous malformation is the underlying cause, it may need to be resected surgically. Other vascular malformations of the brain may also need surgical intervention. If a brain tumor is the cause, it may need to be surgically resected. Sometimes following intracranial hemorrhage the brain can no longer accommodate to reabsorb the amount cerebral spinal fluid being produced. At that point a ventricular-peritoneal shunt surgery may be necessary.

Prognosis An intracerebral hemorrhage can be fatal. Some people die before they arrive to the hospital. Others may not survive the very early phase of the hospitalization. Prognosis depends on the location of the bleed in the brain, extent of blood, degree of brain swelling, and treatments associated with the hospital course. Some patients require care in a skilled nursing facility for several months after discharge from the hospital. And others require stay in an acute rehab facility before they are able to return to their home. There are other patients who discharge to home with minimal neurological deficits and are able to return to their normal activities within weeks. Recovery There will be ongoing evaluations by the physical therapist, occupational therapist and speech therapist working with you throughout the hospitalization. They will help to determine what your discharge rehabilitation needs are for when you prepare to leave the hospital. Your recovery after discharge will depend on many things including how sick you were at the time you first had the hemorrhage, the extent of bleeding you had, and any procedures or complications you had as part of your hospital treatment. In the initial time after hemorrhage you will experience headaches, fatigue, difficulty with concentration, short term memory loss and decreased ability to multitask. These symptoms will gradually improve. You will make steady improvements in your recovery on a week to week basis. Keep in mind that your recovery takes place over the first 18 months following an intracerebral hemorrhage. Some people make complete recoveries. Others must learn to accommodate for a specific neurological deficit. Those deficits may or may not improve over the next 18 months. Each patient and each recovery is different.

Management

• You will have close follow up with your primary care provider following an intracerebral hemorrhage. And if you do not have a primary care provider it is important that you establish care with one now. You will work with your primary care provider to reduce your risk factor profile. • If you have high blood pressure you will need to start recording your blood pressure. Don’t stop your blood pressure medications unless instructed to by your doctor. • If you have diabetes, work with your primary care provider to get it under control. • If you have high cholesterol, work with your primary care provider to get this under control. • If you smoke, STOP NOW. Take advantage of your time in the hospital to stick with quitting. For assistance, call 1-800 NO BUTTS. Also, speak to your primary care provider. There may be medications that can be prescribed to help you quit smoking. • If you must remain on blood thinner medications for another medical problem, you must remain under close supervision of the provider prescribing this medication. You may require frequent surveillance of your blood to make sure your medication dose is appropriate. • Care for your mental and emotional health. Some people suffer from anxiety and depression after this serious illness. Please talk to your doctor or nurse. Sometimes medications can be helpful. Seek counseling or treatment for depression. Exercise will help your mood and emotions as well as your physical recovery. Seek out a local support group if there is any in your community. • If you have a history of alcohol abuse or dependence, you must stop. Please consult with your primary care provider to get help accessing resources. • Stop the use of any illegal drugs. • Adopt a healthy lifestyle by eating right and exercising regularly. Avoid extra salt in the diet and eat plenty of fruit, whole grains and vegetables. Use non-fat or low-fat dairy items. • If surgery was performed you will also have to follow up with your neurosurgeon. Your Health Matters • Unless an appointment has already been made, contact your Primary Care Physician’s office to schedule an appointment within one week of your discharge.

Resources

We encourage you to join a support group if there is one in your area. There are also online resources available. Some are: The Aneurysm and AVM Foundation: www.TAAFonline.org The American Stroke Association: www.strokeassociation.org The Brain Aneurysm Foundation: www.bafound.org National Stroke Association: www.stroke.org

References

* (Taken from “the internet stroke center”) **(Taken from UW Medicine Stroke Center) *** (Taken from Mount Sinai Hospital patient care ICH)

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