Spontaneous intracerebral hemorrhage: a literature review

Miglė Sidaraitė1, Domantas Kunigiškis1, Titas Petruša1

1Lietuvos sveikatos mokslų universitetas, medicinos fakultetas


Intracerebral hemorrhage (ICH) is a subtype of stroke and occurs when blood from cerebral arteries leaks directly into the brain matter. This process can be spontaneous or posttraumatic. Spontaneous intracerebral hemorrhage is divided into primary and secondary ICH. Primary ICH results from the bursting of small intracerebral arteries because of chronic vasculopathy, most commonly caused by long-standing high blood pressure and cerebral amyloid angiopathy (CAA). There are various causes of secondary  ICH, such as vascular malformations, coagulopathy,  ischemic stroke with hemorrhagic conversion, cerebral vasculitis. ICH makes up about 10-15% of all strokes and has significant early mortality and long-term disability rates. ICH is an urgent situation, which needs early diagnostic and stabilization and reassessment of the patient’s airway, breathing, and circulation (ABCs). ICH is diagnosed through a combination of history, physical examination, and, most commonly, non-contrast CT examination of the brain. Noncontrast computed tomography is used to detect clinically relevant brain hemorrhage because of it can be done quickly, can be used for critically ill patients, and has very high sensitivity and specificity for acute parenchymal hemorrhage. Magnetic resonance imaging (MRI) may have a similar sensitivity to identify ICH, but logistics related to availability and the clinical condition of the patient limits its use as a primary modality. Also, CT angiography (CTA), or conventional angiography should be considered if there is a question of a vascular malformation such as an aneurysm or arteriovenous malformation as well it can be used to determine the risk of hematoma re-bleeding. ICH Score is used to evaluate the prognostic outcome of  ICH. Components of the ICH Score include age, initial Glasgow Coma Scale (GCS) score, ICH hematoma volume, ICH hematoma location (supratentorial or infratentorial), and presence of IVH. Each criterion in the ICH Score is associated with an increased risk of mortality and a decreased likelihood of a good functional outcome. ICH is potentially lethal, and survival depends on ensuring early management of several specific issues such as blood pressure, coagulopathy reversal, due to medications if patient is taking anticoagulants, also surgical hematoma evacuation might be considered as a life-saving measure in deteriorating patients.

Keywords: Spontaneous intracerebral hemorrhage,  non-contrast computed tomography, surgical hematoma evacuation, blood pressure, coagulopathy.