Intracerebral Hemorrhage

Definition

Intracerebral hemorrhage (ICH) is a type of stroke caused by spontaneous bleeding into the brain parenchyma, leading to neurological deficits and increased intracranial pressure.

Epidemiology

• Accounts for 10–15% of all strokes worldwide.
• Incidence increases with age; more common in males.
• Higher prevalence in patients with hypertension, anticoagulation therapy, or vascular malformations.
• Risk higher in patients with diabetes, chronic kidney disease, and heavy alcohol use.
• Mortality rate is high: 30–50% within one month.

Etiology

• Hypertension is the most common cause of spontaneous ICH.
• Cerebral amyloid angiopathy in elderly patients.
• Anticoagulant or antiplatelet therapy.
• Vascular malformations: arteriovenous malformations, aneurysms.
• Coagulopathies, trauma, or brain tumors.

Pathophysiology

• Rupture of small arteries leads to hematoma formation within brain parenchyma.
• Hematoma expansion causes mass effect and increased intracranial pressure.
• Secondary injury from perihematomal edema, inflammation, and excitotoxicity.
• Compression of surrounding brain tissue leads to focal neurological deficits.
• Disturbance of cerebral perfusion contributes to ischemic injury in surrounding tissue.