Skip to main content

Intracerebral Hemorrhage: An Overview of Etiology, Pathophysiology, Clinical Presentation, and Advanced Treatment Strategies

  • Chapter
  • First Online:
Management of Bleeding Patients

Abstract

Intracerebral hemorrhage (ICH) is one of the most detrimental subtypes of stroke and accounts for 10–15 % of all strokes. ICH has an incidence of 10–30 cases per 100,000/year and is increasing. Mortality rates still remain poor (30–50 %) and functional dependency after ICH is high (75 %). Up to now, all randomized controlled trials investigating treatment approaches in ICH have failed to document improvements on clinical endpoints. Only a specialized treatment of severely injured patients at dedicated comprehensive stroke centers and neurointensive care units (NICUs) has been shown to be beneficial. Currently, ongoing trials are investigating aggressive blood pressure lowering, hemostatic therapies, different operative strategies, and intraventricular thrombolysis, as well as neuroprotective approaches and brain edema therapies. This chapter will summarize the etiology, pathophysiology, advanced treatment strategies, and novel approaches which are currently under investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Flaherty ML, Woo D, Haverbusch M, Sekar P, Khoury J, Sauerbeck L, et al. Racial variations in location and risk of intracerebral hemorrhage. Stroke. 2005;36(5):934–7 [Research Support, N.I.H., Extramural Research Support, U.S. Gov’t, P.H.S.].

    Article  PubMed  Google Scholar 

  2. Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke. 2009;40(2):394–9 [Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  3. Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, et al. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke. 2008;39(9):2644–91 [Practice Guideline Review].

    Article  PubMed  Google Scholar 

  4. Kim-Han JS, Kopp SJ, Dugan LL, Diringer MN. Perihematomal mitochondrial dysfunction after intracerebral hemorrhage. Stroke. 2006;37(10):2457–62 [Research Support, N.I.H., Extramural].

    Article  PubMed  Google Scholar 

  5. Powers WJ, Zazulia AR, Videen TO, Adams RE, Yundt KD, Aiyagari V, et al. Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage. Neurology. 2001;57(1):18–24 [Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].

    Article  CAS  PubMed  Google Scholar 

  6. Alqadri SL, Qureshi AI. Management of acute hypertensive response in patients with intracerebral hemorrhage. Curr Atheroscler Rep. 2012;14(4):322–7 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  7. Moon JS, Janjua N, Ahmed S, Kirmani JF, Harris-Lane P, Jacob M, et al. Prehospital neurologic deterioration in patients with intracerebral hemorrhage. Crit Care Med. 2008;36(1):172–5 [Research Support, N.I.H., Extramural].

    Article  PubMed  Google Scholar 

  8. Brott T, Broderick J, Kothari R, Barsan W, Tomsick T, Sauerbeck L, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28(1):1–5 [Comparative Study Multicenter Study Research Support, U.S. Gov’t, P.H.S.].

    Article  CAS  PubMed  Google Scholar 

  9. Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38(6):2001–23 [Guideline].

    Article  PubMed  Google Scholar 

  10. Sørensen B, Johansen P, Nielsen GL, Sørensen JC, Ingerslev J. Reversal of the International Normalized Ratio with recombinant activated factor VII in central nervous system bleeding during warfarin thromboprophylaxis: clinical and biochemical aspects. Blood Coagul Fibrinolysis. 2003;14(5):469–77.

    Article  PubMed  Google Scholar 

  11. Freeman WD, Brott TG, Barrett KM, Castillo PR, Deen Jr HG, Czervionke LF, et al. Recombinant factor VIIa for rapid reversal of warfarin anticoagulation in acute intracranial hemorrhage. Mayo Clin Proc. 2004;79(12):1495–500 [Comparative Study].

    Article  CAS  PubMed  Google Scholar 

  12. Ilyas C, Beyer GM, Dutton RP, Scalea TM, Hess JR. Recombinant factor VIIa for warfarin-associated intracranial bleeding. J Clin Anesth. 2008;20(4):276–9.

    Article  CAS  PubMed  Google Scholar 

  13. Tanaka KA, Szlam F, Dickneite G, Levy JH. Effects of prothrombin complex concentrate and recombinant activated factor VII on vitamin K antagonist induced anticoagulation. Thromb Res. 2008;122(1):117–23 [Research Support, Non-U.S. Gov’t].

    Article  CAS  PubMed  Google Scholar 

  14. Rosovsky RP, Crowther MA. What is the evidence for the off-label use of recombinant factor VIIa (rFVIIa) in the acute reversal of warfarin? ASH evidence-based review 2008. Hematology Am Soc Hematol Educ Program. [Case Reports]. 2008:36–8.

    Google Scholar 

  15. Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke. 2004;35(6):1364–7.

    Article  PubMed  Google Scholar 

  16. Qureshi AI. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH): rationale and design. Neurocrit Care. 2007;6(1):56–66 [Clinical Trial].

    Article  CAS  PubMed  Google Scholar 

  17. Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol. 2008;7(5):391–9 [Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  18. Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD. Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl. 2006;96:65–8 [Multicenter Study Randomized Controlled Trial].

    Article  CAS  PubMed  Google Scholar 

  19. Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Surgery for patients with severe supratentorial intracerebral hemorrhage. Neurocrit Care. 2006;5(1):15–20.

    Article  PubMed  Google Scholar 

  20. Steiner T, Kaste M, Forsting M, Mendelow D, Kwiecinski H, Szikora I, et al. Recommendations for the management of intracranial haemorrhage—part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis. 2006;22(4):294–316 [Practice Guideline].

    Article  PubMed  Google Scholar 

  21. Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet. 2009;373(9675):1632–44 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S. Review].

    Article  PubMed  PubMed Central  Google Scholar 

  22. Berger AR, Lipton RB, Lesser ML, Lantos G, Portenoy RK. Early seizures following intracerebral hemorrhage: implications for therapy. Neurology. 1988;38(9):1363–5.

    Article  CAS  PubMed  Google Scholar 

  23. Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Coté R, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000;57(11):1617–22 [Multicenter Study].

    Article  CAS  PubMed  Google Scholar 

  24. Passero S, Rocchi R, Rossi S, Ulivelli M, Vatti G. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia. 2002;43(10):1175–80 [Comparative Study Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  25. Sung CY, Chu NS. Epileptic seizures in intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 1989;52(11):1273–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Hemphill 3rd JC, Morabito D, Farrant M, Manley GT. Brain tissue oxygen monitoring in intracerebral hemorrhage. Neurocrit Care. 2005;3(3):260–70 [Research Support, N.I.H., Extramural Research Support, U.S. Gov’t, P.H.S.].

    Article  PubMed  Google Scholar 

  27. Miller CM, Vespa PM, McArthur DL, Hirt D, Etchepare M. Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduced levels of extracellular cerebral glutamate and unchanged lactate pyruvate ratios. Neurocrit Care. 2007;6(1):22–9 [Clinical Trial Research Support, N.I.H., Extramural].

    Article  CAS  PubMed  Google Scholar 

  28. Hallevi H, Albright KC, Aronowski J, Barreto AD, Martin-Schild S, Khaja AM, et al. Intraventricular hemorrhage: Anatomic relationships and clinical implications. Neurology. 2008;70(11):848–52 [Comparative Study].

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Yeatts SD, Palesch YY, Moy CS, Selim M. High dose deferoxamine in intracerebral hemorrhage (HI-DEF) trial: rationale, design, and methods. Neurocrit Care. 2013;19(2):257–66 [Clinical Trial, Phase II Multicenter Study Randomized Controlled Trial Research Support, N.I.H., Extramural].

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Da Pian R, Bazzan A, Pasqualin A. Surgical versus medical treatment of spontaneous posterior fossa haematomas: a cooperative study on 205 cases. Neurol Res. 1984;6(3):145–51 [Comparative Study].

    Article  PubMed  Google Scholar 

  31. Kirollos RW, Tyagi AK, Ross SA, van Hille PT, Marks PV. Management of spontaneous cerebellar hematomas: a prospective treatment protocol. Neurosurgery. 2001;49(6):1378–86. discussion 86–7.

    Article  CAS  PubMed  Google Scholar 

  32. Morioka J, Fujii M, Kato S, Fujisawa H, Akimura T, Suzuki M, et al. Surgery for spontaneous intracerebral hemorrhage has greater remedial value than conservative therapy. Surg Neurol. 2006;65(1):67–72. [Comparative Study Research Support, Non-U.S. Gov’t], discussion -3.

    Article  PubMed  Google Scholar 

  33. van Loon J, Van Calenbergh F, Goffin J, Plets C. Controversies in the management of spontaneous cerebellar haemorrhage. A consecutive series of 49 cases and review of the literature. Acta Neurochir (Wien). 1993;122(3–4):187–93 [Review].

    Article  Google Scholar 

  34. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365(9457):387–97 [Clinical Trial, Comparative Study, Multicenter Study, Randomized Controlled Trial Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  35. Kirkman MA, Mahattanakul W, Gregson BA, Mendelow AD. The effect of the results of the STICH trial on the management of spontaneous supratentorial intracerebral haemorrhage in Newcastle. Br J Neurosurg. 2008;22(6):739–46. [Multicenter Study], discussion 47.

    Article  CAS  PubMed  Google Scholar 

  36. Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S. Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: a prospective randomized study. Surg Neurol. 2006;66(5):492–501. [Randomized Controlled Trial], discussion-2.

    Article  PubMed  Google Scholar 

  37. Morgenstern LB, Hemphill 3rd JC, Anderson C, Becker K, Broderick JP, Connolly Jr ES, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41(9):2108–29 [Practice Guideline].

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Burhan Z. Chaudhry M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Chaudhry, B.Z., Manno, E.M. (2016). Intracerebral Hemorrhage: An Overview of Etiology, Pathophysiology, Clinical Presentation, and Advanced Treatment Strategies. In: Teruya, J. (eds) Management of Bleeding Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-30726-8_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-30726-8_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30724-4

  • Online ISBN: 978-3-319-30726-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics