Intracerebral hemorrhage is a serious medical condition that calls for an emergency. It is a life-threatening condition that causes acute extravasation of blood into the brain parenchyma. It is the most devastating and disabling type of stroke which occurs when the bleeding occurs within the brain tissue itself. It is a type of stroke which occurs when the brain is deprived of oxygen and blood supply. The heart pumps blood through the network of blood vessels, known as arteries. The blood carries oxygen and nutrients to the brain and other parts of the body and when the blood leaks from the blood vessels or around the brain, it is known as hemorrhagic stroke. Intracerebral hemorrhage is a type of stroke which occurs when an artery inside the brain burst and this blood leaks into the brain tissues at high pressure by killing the cells of the brain.
Intracerebral hemorrhage consists of three phases- initial hemorrhage, hematoma expansion, and peri-hematoma edema. The initial hemorrhage is caused by damage to cerebral arteries due to various risk factors such as hypertension and high alcohol intake. Hematoma expansion occurs hours after the onset of its initial symptoms, that is an increase in the intracellular pressure which disturbs the integrity of the local tissue and the blood brain barrier. Also, the obstructed venous outflow results in local coagulopathy. Lastly, the peri-hematoma edema is responsible for neurological deterioration.
Symptoms of Intracerebral hemorrhage
- Sudden numbness of the face
- Temporary loss of vision
Causes of Intracerebral hemorrhage
Hemorrhagic stroke is mainly caused by the weakening of small arteries in the brain and there are various medical conditions that could lead to this condition and some of them are as follows:
There are various causes of intracerebral hemorrhage but hypertension is still the leading cause of this disease, accounting most of the cases. Hypertension, also known as high blood pressure is a condition which means that the pressure in the arteries is higher than it should be. Normally, blood pressure varies from moment to moment and there are many factors that affect blood pressure such as lifestyle, emotional state, medicines, and alcohol. The problem arises when the blood pressure of the person is persistently high. High blood pressure weakens the small arteries in the brain which causes a stroke. There are various mechanisms through which hypertension causes intracerebral hemorrhage such as high pressure in the intracerebral arteries leads to alterations in the smooth muscle wall and endothelial functions, hence making it more susceptible to intracerebral hemorrhage. These changes affect specific areas of the brain.
After hypertension, cerebral amyloid angiopathy is the second most common cause of intracerebral hemorrhage. Cerebral amyloid angiopathy is defined as the deposition of the protein called amyloid within the small arteries and arterioles of leptomeninges, cerebral cortex, basal ganglia, brainstem, and cerebellum. An increase in the protein results in the damage that causes bleeding due to vessel tear. It is more common in older people. Hypertension or high blood pressure is closely linked to cerebral amyloid angiopathy and the most recommended treatment for this disease is to control high blood pressure. It is considered to be a common feature that is associated with normal aging, Alzheimer’s disease, down syndrome, and sporadic cerebral amyloid angiopathy.
A cerebral aneurysm is a bulge in the walls of an artery in the brain due to the weakening of the artery wall and as an aneurysm enlarges, it put the pressure on the surrounding structures and causes a headache, vision problem and sometimes even a rupture. When an aneurysm ruptures, the blood bursts into the space between arachnoid membrane and the pia mater under arterial pressure and it continues until the intracranial pressure stops bleeding. A ruptured cerebral is highly associated with morbidity and mortality and a burst an aneurysm is the most common cause of hemorrhage stroke. After 5 to 10 days of aneurysm ruptures, the complication that occurs is known as vasospasm and it leads to the spasm and narrowing of the arteries of the walls. As a result, it reduces the blood flow to that region of the brain and hence causing a stroke. Most often, aneurysm occurs in people between the age of 35 and 60 and it is more likely to develop in women as compared to men.
Arteriovenous malformations is a vascular abnormality consists of an abnormal tangle of blood vessels in the brain or spine. Normally, a capillary bed is where the blood exchanges oxygen and nutrients with the body tissues. But in arteriovenous malformations, arteries connect directly to the veins without capillary bed which causes a fistula. The veins are unable to handle the extra blood and as a result, it enlarges. This weakens the blood vessels and this weakened blood vessel can rupture and bleeds which increases the risk of developing an aneurysm.