Intracerebral Hemorrhage

Abstract

Intracerebral hemorrhage (ICH) refers to bleeding within the brain parenchyma. ICH represents 10–15% of all strokes, second only to ischemic strokes. ICH is classified as traumatic and nontraumatic; the latter is further divided into primary and secondary ICH. This chapter will focus on nontraumatic ICH. Secondary nontraumatic ICH occurs in the setting of coagulopathy or macroscopic anatomical anomalies, like vascular malformations and tumors. Primary ICH occurs in the absence of the triggers that define secondary ICH and is often the final manifestation of chronic small-vessel diseases of the brain. Hemorrhagic transformation of an ischemic stroke has a distinct pathophysiology and management and is discussed in a separate chapter. The management of each patient depends on the underlying etiology of the hemorrhage; it is therefore important to not only perform a thorough history and physical exam, but also tailor the work-up and treatment to each case. In the critical care setting, management is focused on addressing cerebral edema, intracranial pressure, blood pressure, fever, and blood glucose.