What is the Intracranial Hemorrhage?

Intracranial hemorrhage (ICH) refers to any bleeding within the intracranial vault, including the brain parenchyma and surrounding meningeal spaces. ICH falls into four broad categories: Epidural hematoma (EDH), Subdural hematoma (SDH), Subarachnoid hemorrhage (SAH), and Intracerebral hemorrhage. The difference between the terms intracranial hemorrhage and intracerebral hemorrhage is that the former refers to all bleeding occurring within the skull, while the latter indicates bleeding within the brain parenchyma.

All ICH share some classic clinical features. Common presenting symptoms include headache, nausea, vomiting, confusion, somnolence, or seizure. In elderly, alcoholic, and anticoagulated patients, even minor head trauma can result in devastating intracranial bleeding.

The most important risk factors for ICH include hypertension (HTN) and cerebral amyloid angiopathy (CAA). HTN-related ICH is more likely to occur in deep structures, and the risk of ICH increases with increasing blood pressure values. CAA tends to occur in association with advanced age, and CAA-related ICH tends to occur in lobar regions.

Primary ICH is typically a manifestation of underlying small vessel disease. First, longstanding hypertension leads to hypertensive vasculopathy causing microscopic degenerative changes in the walls of small-to-medium penetrating vessels, which is known as lipohyalinosis. Second, CAA is characterized by the deposition of amyloid-beta peptide (Aβ) in the walls of small leptomeningeal and cortical vessels. The final consequences are degenerative changes in the vessel wall characterized by the loss of smooth muscle cells, wall thickening, luminal narrowing, microaneurysm formation and microhemorrhages

The first step to diagnose ICH is a CT scan of head. A CT scan can show abnormalities in the brain like swelling or clots. The CT scan may not show any sign of ICH. If still symptoms occur, lumbar puncture, or spinal tap, to test the fluid that cushions the spine and brain is performed. MRI, Angiogram, X-Ray are also used for diagnosis.

Check more about Intracranial hemorrhage Pipeline

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