Intracerebral%20hemorrhage Signs and Symptoms

• Intracerebral hemorrhage (ICH) is the result of a blood vessel rupture within the brain and the blood leaks out to form a hematoma
  • Accumulated blood compress, distort and disrupt surrounding brain structures
• Sudden onset of focal or global cerebral dysfunction is manifested
  • Focal neurologic findings are related to the anatomic location, size and speed of development of ICH
• Neurological deficit usually progresses over a minute to an hour

• Most common manifestation of a chronic, progressive disorder of the brain’s blood vessels and affects more than 2 million people annually worldwide
• Accounts for 10-20% of all strokes
• Global incidence rate of stroke due to hemorrhage was 15-40%, with >15% observed more in Asia compared to developed countries in North America and Western Europe
• Incidence increases at 55 years old and continues to increase with age
• Age-standardized stroke prevalence rates of ICH was high in East and Central Asia
• Men are more likely to experience ICH than women
• In 2017, among the 6.2 million deaths caused by cerebrovascular disease globally, 3 million deaths were due to ICH
  • Mortality rate was highest in East and Southeast Asia

• Non-traumatic ICH is most often caused by blood vessel rupture secondary to hypertensive damage
• May also be caused by structural abnormalities such as vascular malformation, neoplasm, or inflammation

Primary Causes

• Arterial hypertension
• Cerebral amyloid angiopathy (CAA)

Secondary Causes

• Cerebral venous and sinus thrombosis
  • Sinus thrombosis
  • Deep cerebral venous thrombosis
  • Cortical venous thrombosis
• Vascular malformation
  • Arteriovenous malformation
  • Dural arteriovenous fistula
  • Cavernous malformation
• Intracranial neoplasms
  • Primary intracerebral tumors
  • Metastases
• Coagulopathies
  • Congenital bleeding disorders
  • Coagulopathic liver disease
  • Trombocytopenia
  • Drug-induced coagulopathy
• Infection
  • Herpes simplex virus
  • Septic emboli, mycotic aneurysms
• Intracranial aneurysm
• Hemorrhagic transformation of cerebral infarct
• Vasculitis
• Moyamoya disease

Modifiable

• Hypertension
  • Chronic hypertension accounts for 56% of attributable risk for the incidence of ICH
• Diabetes
• Smoking
• Alcohol consumption
• Diet
• Hyperlipidemia
• Obesity (waist-hip-ratio)
• Medications (eg anticoagulants, antiplatelets, decongestants, antihypertensives, stimulants, sympathomimetics)
• Illicit drug use (eg cocaine, heroin, amphetamine)

 Non-modifiable

• Advanced age
• Male sex
• Asian ethnicity
• Chronic kidney disease
• Liver disease
• Hematologic disease
• Cancer
• Recent trauma or surgery

Rapid recognition and diagnosis of ICH are essential because of frequent rapid progression

Warning Signs

• Nausea and vomiting (N/V)
• Severe headache
• Decreased consciousness or coma
• Elevated systolic blood pressure (SBP)

Initial Survey and Management

• Ensure the status of the patient’s airway, breathing and circulation
  • Intubate if insufficient ventilation (pO2 <60 mmHg/7.9 kPa or pCO2 >50 mmHg/6.3 kPa), cyanosis, impending respiratory failure, obvious aspiration risk, or depressed level of consciousness
• Detection of focal neurological deficits
• Detection of signs of external trauma
• Admit in an intensive care unit (ICU) or acute stroke unit for at least the 1st 24-72 hours