Deep intracerebral hemorrhage is a type of stroke caused by bleeding within the deep structures of the brain (thalamus, basal ganglia, pons, and cerebellum).

Intracranial bleed

Deep intracerebral hemorrhage can affect any person regardless of age, sex, or race, though it is more common in older people. It may be caused by head injury (trauma), bleeding into a tumor, problems with blood vessels (such as a cerebral aneurysm or angioma) or blood clotting problems. In some cases, no cause can be found.

Bleeding in the brain irritates the brain tissues, causing swelling (cerebral edema). The blood may collect into a mass (hematoma). Both cerebral edema and the presence of a hematoma within the brain put increasing pressure on the brain tissues and eventually destroy them.

Risk factors for deep intracerebral hemorrhage include:

• Various blood or bleeding disorders
  • Disseminated intravascular coagulation (DIC)
  • Hemophilia
  • Sickle cell anemia
  • Leukemia
  • Decreased blood platelets
• Use of aspirin or anticoagulant medications (blood thinners)
• Liver disease (associated with increased bleeding risk)

See also:

Hypertensive intracerebral hemorrhage

• Headache, which may:
  • Occur when lying flat
  • Cause you to wake up
  • Increase when you change positions
  • Start suddenly
  • Increase when you bend, strain, or cough
• Nausea or vomiting
• Change in alertness (level of consciousness)
  • Apathetic, withdrawn
  • Sleepiness, lethargy, stupor
  • Unconsciousness, coma
• Decreased vision
• Loss of all or part of vision
• Sensation changes, usually on only one side of the body
  • Decreased sensation
  • Numbness or tingling
  • Abnormal sensations
• Difficulty speaking or understanding others
• Difficulty swallowing
• Difficulty writing or reading
• Movement changes, usually on only one side of the body
  • Weakness of any body part
  • Difficulty moving any body part
  • Loss of fine motor skills
• Loss of coordination
• Loss of balance
• Seizure

The symptoms vary depending on the location of the bleed and the amount of brain tissue affected. Symptoms most commonly develop suddenly, without warning, often during activity. They may be episodic (occurring and then stopping) or slowly get worse over time.

A neurological exam may suggest increased intracranial pressure or decreased brain functions. The person's specific symptoms can help tell which part of the brain is affected. For example, sudden nausea, vomiting, loss of balance, headache, and a rapid decrease in consciousness can mean a bleed in the cerebellum or brainstem.

An eye exam may show swelling of the optic nerve from pressure in the brain, or there may be changes in eye movement. Abnormal reflexes may be present.

Tests may include:

• CBC
• Platelet count
• Bleeding time
• Prothrombin time (PT) or partial thromboplastin time (PTT)
• Liver function tests
• Kidney function tests
• Head CT (may be preferred if bleed is less than 48 hours old)
• MRI of head
• Angiogram