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Diagnosis and Treatments
Intracerebral hemorrhage (ICH) is a type of stroke caused by bleeding within the brain. The blood collects and forms a clot, called "hematoma," which grows and causes pressure on surrounding brain tissue. ICH is a life-threatening condition, most commonly caused by hypertension (high blood pressure), amyloid angiopathy, and head trauma. As blood cells within the clot die, toxins are released that further damage brain cells in the area surrounding the hematoma. Acute treatment is focused preventing ongoing bleeding and removing the hematoma in selected patients to relieve the pressure on the brain. Ten percent of strokes are caused by ICH (approximately 70,000 new cases each year), which carries a 40 percent risk of death. ICH is more common in men, middle-aged African Americans, and Japanese. Approximately 70 percent of patients experience long-term deficits after an ICH.
Symptoms of ICH may include:
- Headache, nausea and vomitingLethargy or confusion
- Sudden weakness or numbness of the face, arm, or leg, usually on one side
- Loss of consciousness
- Temporary loss of vision
Causes of ICH may include:
- High blood pressure
- Anticoagulants (blood thinning therapy)
- Arteriovenous malformations (tangle of abnormal arteries and veins)
- Ruptured aneurysm
- Head trauma
- Bleeding disorders
- Amyloid angiopathy (a degenerative disease of the arteries in elderly patients)
- Illicit drug usage
An aneurysm is a balloon-like bulge in a weak area of the arterial wall. Aneurysms are liable to enlarge, and this can cause pressure on the surrounding brain structures according to the aneurysm's location. The aneurysm wall may become weaker as the aneurysm becomes larger and can rupture resulting in a life threatening type of stroke called subarachnoid hemorrhage (SAH), which is blood around the brain.
Aneurysms are usually diagnosed between ages 35 to 60 and are more common in women. Unruptured aneurysms are found in 2.7 million patients each year, and ruptured aneurysms are found in 20,000 patients each year. Risk factors for aneurysm rupture include smoking, high blood pressure, alcohol intake, cocaine abuse, genetics (family inherited), atherosclerosis of cerebral arteries (hardening of the arterial wall), oral contraceptives, and stressful lifestyle.
Symptoms may include:
- Mild headache, stiff neck
- Vision problems, moderate to severe headache, stiff neck
- Lethargy or confusion, weakness or partial paralysis on one side of body
- Stupor, moderate to severe paralysis on one side of body
Treatment of unruptured aneurysms includes observation and imaging using CTA or MRA, surgical clipping, or coiling.
Ruptured aneurysms are treated by surgical clipping or endovascular coiling. The best treatment option of surgical clipping versus endovascular coiling depends upon the size and location of the aneurysm, patient's age, and patient's health/clinical condition.
Subarachnoid hemorrhage (SAH) is a type of stroke caused by bleeding into the space in the area between the brain and the skull which normally contains cerebrospinal fluid (CSF). SAH can be caused by a ruptured aneurysm, head trauma, or bleeding arteriovenous malformation (AVM). SAH occurs in 1 out of 10,000 people each year. Five to 10 percent of all strokes are due to SAH.
Treatment focuses on controlling the source of bleeding, restoring normal blood flow to the brain, and relieving the pressure within the brain.
Vasular malformations of the brain and the spinal cord are classified as follows:
- Arteriovenous malformations (AVM): an abnormal collection of blood vessels without normal brain tissue in-between
- Cavernous malformation (also known as cavernoma, cavernous angioma, cavernous hemangioma): a collection of dilated irregular venous spaces without normal brain tissue in-between
- Dural arteriovenous fistula: connection between arteries and veins within the dura matter layers (covering of the brain) creating abnormal shunts
- Venous angiomas: a tuft of functionally draining veins which can be superficial or deep and most often do not require treatment
Treatment for vascular malformations can include surgical resection, endovascular embolization, and stereotactic radiation therapy.