Definition
- Intracerebral hemorrhage (ICH) results from a blood vessel rupture within the brain with blood leaking out to form a hematoma
- Accumulated blood compress, distort and disrupt surrounding brain structures
- Most common manifestation of a chronic, progressive disorder of the brain’s blood vessels
- Sudden onset of focal or global cerebral dysfunction is manifested
- Focal neurologic findings are related to the anatomic location, size and speed of development of ICH
- Neurological deficit usually progresses over minutes to an hour
Sinh lý bệnh
- Causes brain injury as a result of:
- Direct pressure effects of an acutely expanding mass lesion which include local compression of immediately surrounding brain tissue and more widespread mechanical injury caused by increased intracranial pressure (ICP), hydrocephalus or herniation
- Secondary physiological and cellular injury including cerebral edema, inflammation and biochemical toxicity of metabolized blood products such as hemoglobin, iron and thrombin
Signs and Symptoms
Adjunctive Global Symptoms
- Nausea and vomiting (N/V)
- Severe headache
- Decreased consciousness or coma
- Elevated systolic blood pressure (SBP)
Dịch tễ học
- In 2019, 3.4 million new cases of ICH annually were reported accounting for over 28% of all incident strokes globally
- Incidence is higher in low- and middle-income countries and higher in men than women
- Incidence is higher in Asia
- Prevalent in 21 million people globally
- Deaths due to ICH were reported at 3 million annually in 2019
- Mortality rate was highest in East and Southeast Asia
- Global incidence rate of stroke due to hemorrhage was 15-40%, with >15% observed more in Asia compared to developed countries in North America and Western Europe
- Age-standardized stroke prevalence rates of ICH were high in East and Central Asia
Nguyên nhân
Primary Causes
- Arterial hypertension
- Non-traumatic ICH is most often caused by blood vessel rupture secondary to hypertensive damage
- Arteriolosclerosis (also known as lipohyalinosis) of the cerebral small vessels
- Seen as concentric hyalinized vascular wall thickening in the penetrating arterioles of the basal ganglia, thalamus, brainstem and deep cerebellar nuclei
- Major risk factors include age, diabetes and hypertension
- Cerebral amyloid angiopathy (CAA)
- Deposition of β-amyloid peptide in the walls of arterioles and capillaries in the leptomeninges, cerebral cortex and cerebellar hemispheres
- Risk factors include age and apolipoprotein E genotypes containing the ε3 or ε4 alleles
Secondary Causes
- Dural venous sinus thrombosis
- Arteriovenous malformation
- Dural arteriovenous fistula
- Cavernous malformation/angioma
- Intracranial neoplasm, metastases
- Congenital bleeding disorders
- Coagulopathic liver disease
- Thrombocytopenia
- Drug-induced coagulopathy
- Herpes simplex virus
- Septic emboli, mycotic aneurysms
- Intracranial aneurysm
- Hemorrhagic transformation of cerebral infarct
- Vasculitis
- Moyamoya disease
- Reversible cerebral vasoconstriction syndrome
Yếu tố nguy cơ
- Age: Risk of ICH increases with age
- History of hypertension, diabetes, hypercholesterolemia, obesity, chronic kidney disease, liver or hematologic disease, cancer, dementia, and seizures
- Chronic hypertension accounts for 56% of attributable risk for the incidence of ICH
- Medications (eg anticoagulants, antiplatelets, decongestants, antihypertensives, stimulants, sympathomimetics)
- Recent trauma or surgery (eg carotid endarterectomy, stenting)
- Alcohol, smoking, illicit drug use (eg cocaine, heroin, amphetamine)
- Race and ethnicity