Neuro Insights
An intracerebral hemorrhage, or ICH, happens when a blood vessel bursts and causes bleeding inside the brain. It is different from an ischemic stroke, which happens when a blood vessel becomes blocked. The bleeding can put pressure on the brain, damage nearby tissue, and affect how the brain normally works.¹
Since the skull has very little extra space, blood and swelling can quickly increase pressure on the brain. This means that even a small bleed can become serious. Hemorrhagic strokes are not as common as ischemic strokes, but they are often more severe and need immediate medical treatment.²
What Happens During an Intracerebral Hemorrhage?
During an intracerebral hemorrhage, a weakened blood vessel bursts and blood leaks into the brain. The blood collects and forms a pool called a hematoma. As the hematoma gets larger, it can press against nearby brain tissue and reduce the amount of oxygen reaching that area.
The bleeding can also cause inflammation and swelling, which may continue after the initial bleeding has stopped. Because of this, treatment focuses on controlling the bleeding, preventing the hematoma from growing, and reducing pressure on the brain.³
Common Causes and Risk Factors
Long-term high blood pressure is one of the main risk factors for an intracerebral hemorrhage. Over time, it can weaken the small arteries in the brain and make them more likely to burst.¹
Other possible causes include aneurysms, abnormal blood vessels, head injuries, brain tumors, bleeding disorders, and blood-thinning medications. In older adults, a condition called cerebral amyloid angiopathy can also make bleeding in the brain more likely.³
Common risk factors include:
- High blood pressure
- Smoking
- Heavy alcohol use
- Older age
- Taking anticoagulants or other blood thinners
- A previous stroke
- Certain blood vessel abnormalities
Signs and Symptoms
Symptoms of intracerebral hemorrhage usually appear suddenly. They depend on where the bleeding occurs in the brain and how large the bleed is.
Possible symptoms include:
- Sudden weakness, numbness, or paralysis, especially on one side of the body
- Sudden confusion or trouble speaking
- Severe headache
- Nausea or vomiting
- Dizziness or loss of balance
- Vision changes
- Sleepiness or decreased alertness
- Seizures
- Loss of consciousness
Because these symptoms can progress quickly, ICH is a medical emergency. The CDC recommends calling 911 right away if someone develops sudden stroke symptoms, including facial drooping, arm weakness, speech difficulty, confusion, vision problems, dizziness, or a severe headache.⁴
How Is It Diagnosed?
Doctors usually diagnose intracerebral hemorrhage with brain imaging. A CT scan is often used first because it can quickly show whether bleeding is present in the brain. MRI may also be used to provide more detailed images or help identify the underlying cause of the hemorrhage.
Additional tests may include blood work to check clotting ability, platelet levels, and the effects of blood-thinning medications. In some cases, doctors may order CT angiography or MR angiography to look for aneurysms or abnormal blood vessels.
Treatment Options
Treatment depends on the size and location of the bleed, the patient’s symptoms, and the cause of the hemorrhage. The main goals are to prevent the bleeding from worsening, lower pressure in the brain, control blood pressure, and reduce complications.
Emergency treatment may include medications to lower blood pressure, reverse blood thinners, prevent seizures, or reduce swelling. The American Heart Association and American Stroke Association emphasize blood pressure management and reversal of anticoagulation as important parts of acute ICH care.³
Some patients may need surgery. Surgery may be considered if the hematoma is large, if pressure inside the skull is dangerously high, or if there is an underlying blood vessel problem that needs repair. In other cases, patients may be treated with close monitoring in an intensive care unit or specialized stroke unit.
Recovery and Long-Term Effects
Recovery after intracerebral hemorrhage can vary widely. Some people recover many of their abilities, while others may have lasting disability. The outcome often depends on the size of the bleed, the area of the brain affected, how quickly treatment begins, and the person’s overall health.
Long-term effects can include weakness, speech problems, memory changes, swallowing difficulty, seizures, mood changes, and problems with walking or coordination. Rehabilitation is often an important part of recovery and may include physical therapy, occupational therapy, speech therapy, and cognitive support.
Prevention
The best way to lower the risk of intracerebral hemorrhage is to manage controllable risk factors. Blood pressure control is especially important because hypertension is a major contributor to hemorrhagic stroke.¹
Prevention may include taking blood pressure medication as prescribed, avoiding smoking, limiting heavy alcohol use, managing diabetes and cholesterol, exercising regularly, and discussing the risks of blood thinners with a healthcare provider.
Intracerebral hemorrhage is sudden, serious, and potentially life-threatening. However, early recognition and emergency treatment can improve the chances of survival and recovery.
1 Centers for Disease Control and Prevention. About Stroke.
2 National Institute of Neurological Disorders and Stroke. Stroke Overview.
3 American Heart Association/American Stroke Association. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage.
4 Centers for Disease Control and Prevention. Signs and Symptoms of Stroke.
5 Cleveland Clinic. Brain Bleed: Causes and Symptoms.
6 Mayo Clinic. Intracranial Hematoma: Symptoms and Causes.
