Patient education: Intracerebral hemorrhage (The Basics)

What is an intracerebral hemorrhage? — 

This is bleeding in the brain. "Intracerebral" means within the brain, and "hemorrhage" means bleeding.

An intracerebral hemorrhage is a type of stroke (figure 1). It is sometimes called "hemorrhagic stroke." A stroke is when a part of the brain is damaged because of a problem with blood flow. Most strokes happens when a blood vessel to the brain gets clogged or closes off. But bleeding inside the brain can also cause a stroke.

If a person has untreated high blood pressure for a long time, this can lead to an intracerebral hemorrhage. It can also happen if there are problems with the blood vessels in the brain, including changes that can happen with age. Other things that can cause bleeding in the brain include tumors, certain infections, and head injuries.

What are the symptoms of an intracerebral hemorrhage? — 

Symptoms usually start suddenly, like with other types of stroke.

One way to help remember stroke symptoms is to think of the words "BE FAST" (figure 2). Each letter in the word stands for 1 thing you should watch for and what to do:

●Balance – Is the person having trouble standing or walking?

●Eyes – Are they having trouble with their vision?

●Face – Does their face look uneven or droop to 1 side?

●Arm – Do they have weakness or numbness in 1 or both arms? Does 1 arm drift down if they try to hold both arms out?

●Speech – Are they having trouble speaking? Does their speech sound strange?

●Time – If you see any of these signs, call for an ambulance right away (in the US and Canada, call 9-1-1). You need to act FAST and get to a hospital. The sooner treatment begins, the better the chances of recovery.

An intracerebral hemorrhage can also cause other symptoms. These depend on the size and location of the bleeding. They can include:

●A sudden, severe headache

●Nausea and vomiting

●Seizures

●Passing out

●New or worsening confusion

Is there a test for intracerebral hemorrhage? — 

Yes. In the hospital, doctors will do imaging tests to create pictures of the brain. These include:

●CT scan

●MRI

These tests can show if there is bleeding in or around the brain.

The doctors might do other tests to figure out the cause of bleeding. For example, they might order blood tests to check for a bleeding disorder.

How is an intracerebral hemorrhage treated? — 

Your doctor might:

●Give you medicines and other treatments to reduce the brain damage caused by the bleeding

●Give you medicines to lower your blood pressure, if it is high

●Stop any of your medicines that prevent blood from clotting. These are sometimes called "blood thinners." These include aspirin, warfarin (brand name: Jantoven), apixaban (brand name: Eliquis), and similar medicines used to prevent or treat blood clots. If you take any of these, your doctor might give you treatments to help your blood clot so you stop bleeding.

●Watch the pressure in your brain to make sure it doesn't get too high

Some people also get surgery, depending on their symptoms and situation. Doctors can do surgery to:

●Remove a piece of the skull to relieve pressure on the brain and prevent more damage

●Remove a collection of blood, if it is pressing down on the brain or making the brain swell

●Fix the blood vessel that was bleeding

Can an intracarebral hemorrhage be prevented? — 

Sometimes. You can lower your chance of having an intracerebral hemorrhage if you:

●Get treated for high blood pressure – This is very important. Untreated high blood pressure is a common cause of intracerebral hemorrhage. Treatment can involve lifestyle changes, diet changes, and medicines.

●Quit smoking, if you smoke. Your doctor or nurse can help.

●Avoid or limit alcohol, and do not use recreational drugs.

●Follow your doctor's instructions about medicines. Some increase the risk of intracerebral hemorrhage.

●Eat a healthy diet with plenty of fruits, vegetables, and whole grains.

●Get regular physical activity. Even gentle forms of exercise, like walking, are good for your health.

If an abnormal blood vessel caused the hemorrhage, your doctor might recommend surgery. This can sometimes fix the blood vessel and prevent it from bleeding again.

What will my life be like? — 

Some people recover from an intracerebral hemorrhage without long-term or serious problems. But many people lose important brain functions. For example, they might be unable to speak, feed themselves, or move 1 side of their body. Specialists can help with these things. For example, you might work with an occupational therapist, physical therapist, speech therapist, or other specialist.

After an intracerebral hemorrhage, people are also more likely to get other medical problems. These can include blood clots in the legs, heart problems, bed sores, or lung infections. Your doctor or nurse will try to prevent these problems from happening and will treat them if they do happen.

More on this topic

Patient education: Stroke (The Basics)
Patient education: Lowering the risk of having a stroke (The Basics)
Patient education: Recovery after stroke (The Basics)
Patient education: Taking care of someone after a stroke (The Basics)
Patient education: Stroke rehabilitation exercises (The Basics)
Patient education: Brain aneurysm (The Basics)
Patient education: High blood pressure in adults (The Basics)
Patient education: Clot-dissolving medicines for heart attack or stroke (The Basics)
Patient education: Anticoagulant medicines – Uses and kinds (The Basics)
Patient education: How to take anticoagulants safely (The Basics)
Patient education: What are clinical trials? (The Basics)
Patient education: Carotid ultrasound (The Basics)

Patient education: Stroke symptoms and diagnosis (Beyond the Basics)
Patient education: Hemorrhagic stroke treatment (Beyond the Basics)