Treatment Guideline Chart
Intracerebral hemorrhage is the sudden burst of blood into the brain tissue itself.
It causes sudden onset of focal neurological deficit.
The focal neurologic findings are related to the anatomic location, size and speed of development of intracerebral hemorrhage.
Neurological deficit usually progresses over a minute to an hour.
Rapid recognition and diagnosis of intracerebral hemorrhage are essential because of its frequently rapid progression.

Intracerebral%20hemorrhage Signs and Symptoms


  • Intracerebral hemorrhage (ICH) is the result of a blood vessel rupture within the brain and the blood leaks out to form a hematoma
    • Accumulated blood compress, distort and disrupt surrounding brain structures
  • 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 a minute to an hour


  • Most common manifestation of a chronic, progressive disorder of the brain’s blood vessels and affects more than 2 million people annually worldwide
  • Accounts for 10-20% of all strokes
  • 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
  • Incidence increases at 55 years old and continues to increase with age
  • Age-standardized stroke prevalence rates of ICH was high in East and Central Asia
  • Men are more likely to experience ICH than women
  • In 2017, among the 6.2 million deaths caused by cerebrovascular disease globally, 3 million deaths were due to ICH
    • Mortality rate was highest in East and Southeast Asia


  • Non-traumatic ICH is most often caused by blood vessel rupture secondary to hypertensive damage
  • May also be caused by structural abnormalities such as vascular malformation, neoplasm, or inflammation


Primary Causes

  • Arterial hypertension
  • Cerebral amyloid angiopathy (CAA)

Secondary Causes

  • Cerebral venous and sinus thrombosis
    • Sinus thrombosis
    • Deep cerebral venous thrombosis
    • Cortical venous thrombosis
  • Vascular malformation
    • Arteriovenous malformation
    • Dural arteriovenous fistula
    • Cavernous malformation
  • Intracranial neoplasms
    • Primary intracerebral tumors
    • Metastases
  • Coagulopathies
    • Congenital bleeding disorders
    • Coagulopathic liver disease
    • Trombocytopenia
    • Drug-induced coagulopathy
  • Infection
    • Herpes simplex virus
    • Septic emboli, mycotic aneurysms
  • Intracranial aneurysm
  • Hemorrhagic transformation of cerebral infarct
  • Vasculitis
  • Moyamoya disease

Risk Factors


  • Hypertension
    • Chronic hypertension accounts for 56% of attributable risk for the incidence of ICH
  • Diabetes
  • Smoking
  • Alcohol consumption
  • Diet
  • Hyperlipidemia
  • Obesity (waist-hip-ratio)
  • Medications (eg anticoagulants, antiplatelets, decongestants, antihypertensives, stimulants, sympathomimetics)
  • Illicit drug use (eg cocaine, heroin, amphetamine)


  • Advanced age
  • Male sex
  • Asian ethnicity
  • Chronic kidney disease
  • Liver disease
  • Hematologic disease
  • Cancer
  • Recent trauma or surgery

Emergency Measures

Rapid recognition and diagnosis of ICH are essential because of frequent rapid progression

Warning Signs

  • Nausea and vomiting (N/V)
  • Severe headache
  • Decreased consciousness or coma
  • Elevated systolic blood pressure (SBP)

Initial Survey and Management

  • Ensure the status of the patient’s airway, breathing and circulation
    • Intubate if insufficient ventilation (pO2 <60 mmHg/7.9 kPa or pCO2 >50 mmHg/6.3 kPa), cyanosis, impending respiratory failure, obvious aspiration risk, or depressed level of consciousness
  • Detection of focal neurological deficits
  • Detection of signs of external trauma
  • Admit in an intensive care unit (ICU) or acute stroke unit for at least the 1st 24-72 hours
Editor's Recommendations
Special Reports