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Intracerebral Hemorrhage
Intracerebral hemorrhage (ICH) is a type of stroke caused by bleeding directly into the brain parenchyma, forming a hematoma that can compress or damage surrounding brain tissue.
Definition
Intracerebral hemorrhage refers to bleeding within the brain parenchyma, not secondary to trauma.
Epidemiology
It represents approximately 10–15% of all strokes and carries a high mortality and morbidity rate.
Common Causes
- Chronic hypertension (most frequent)
- Cerebral amyloid angiopathy (especially in the elderly)
- Arteriovenous malformations (AVMs)
- Anticoagulant or antiplatelet therapy
- Coagulopathies
- Hemorrhagic transformation of ischemic infarct
- Brain tumors
- Drug use (e.g., cocaine, amphetamines)
Clinical Presentation
- Sudden focal neurological deficit (e.g., hemiparesis, aphasia)
- Headache
- Nausea and vomiting
- Altered level of consciousness
- Seizures (less common)
- Signs of elevated intracranial pressure
Diagnosis
- CT scan (non-contrast): first-line for rapid detection
- MRI: useful for subacute/chronic hemorrhage or identifying underlying lesions
- Laboratory studies to assess coagulopathy
Management
- Blood pressure control (e.g., SBP < 140–160 mmHg depending on case)
- Reversal of anti*