Hypertensive intracerebral hemorrhage Health Article

Definition

Hypertensive intracerebral hemorrhage is type of stroke involving bleeding in the brain caused by high blood pressure. See also:

• Hemorrhagic stroke

Causes, incidence, and risk factors

Intracerebral hemorrhage can affect anybody, but it is most common in older people.

Hypertensive intracerebral hemorrhage is caused by long-term high blood pressure (hypertension). When blood pressure has remained high for a significant period of time, the walls of blood vessels change. Constant, high blood pressure wears away at the vessel walls and can lead to blockage of the vessels and leakage of blood into the brain. Blood irritates the brain tissues, causing swelling (cerebral edema). The blood collects into a mass called a hematoma.

Brain tissue swelling and a hematoma within the brain put increased pressure on the brain and can eventually destroy it.

Bleeding may occur in the hollow spaces (ventricles) in the center part of the brain or into the subarachnoid space (the space between the brain and the membranes that cover the brain). Such bleeding can cause symptoms of meningitis.

However, even in patients without known high blood pressure, cocaine use can cause intracerebral hemorrhages.

Symptoms

Symptoms depend on the location of the bleeding in the brain and how much damage has occurred. Symptoms most commonly develop suddenly, without warning, often during activity. There is a rapid loss of function(s) on one side of the body.

The symptoms can be the same as those that result from too little blood flow to the brain (stroke), and may include:

• Vision changes
  • Any change in vision
  • Loss of vision off to one side
  • Decreased vision
• Sensation changes
  • Numbness, tingling
  • Decreased sensation
  • Abnormal sensations
• Movement changes
  • Weakness of any body part
  • Difficulty moving any body part
  • Loss of fine motor skills
• Difficulty speaking or understanding others
• Difficulty swallowing
• Difficulty reading or writing
• Loss of coordination
• Loss of balance
• Seizure
• Headache
  • When lying flat
  • May awaken from sleep
  • Increases with change in position, bending, straining, coughing
• Nausea, vomiting
• Decreased consciousness
  • Apathetic, withdrawn
  • Sleepy, lethargic, somnolent, stuporous
  • Unconscious, comatose

Signs and tests

A neurological exam may show signs of increased pressure in the brain, such as swelling of the optic nerve or changes in eye movement. The doctor will check your reflexes and movement to see if there have been any changes in brain function.

Changes in function may help reveal the location of the problem within the brain.

In order to be classified as a hypertensive hemorrhage, the person must have some history of high blood pressure. Often the blood pressure is still very high when the patient is examined. Other tests may show other signs of high blood pressure, such as abnormal blood vessels in the eyes or problems with kidney function.

Tests to determine the amount and cause of bleeding include:

• CBC
• Platelet count
• Bleeding time
• Prothrombin time
• Partial thromboplastin time
• Liver function tests
• Kidney function tests
• Angiography of the head (if symptoms allow enough time to perform this test) -- reveals any aneurysm or arteriovenous malformation present

However, an image of the brain is needed to prove the condition is due to intracerebral hemorrhage. This can be done with a:

• Head CT scan (preferred if the hemorrhage began less than 48 hours earlier)
• Head MRI