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Cerebral Hemorrhages (Intracerebral Hemorrhage, Hemorrhagic Stroke)

Cerebral hemorrhage (or intracerebral hemorrhage) is an acute neurological condition caused by the lesion of one or more blood vessels in the brain, resulting in blood extravasation (bleeding) into the brain parenchyma. It accounts for approximately 10-15% of all strokes and is associated with high mortality and disability. The most common sites of bleeding include the basal ganglia, the thalamus, the pons, and the cerebellum. Intracerebral hemorrhage must be distinguished from cerebral hemorrhage in a broader sense, which also includes subdural hemorrhage, epidural hemorrhage, and subarachnoid hemorrhage, which fall under multi-specialty competence (mainly neuroradiological and neurosurgical, and only partly neurological).

The primary cause is chronic arterial hypertension, which progressively weakens the small cerebral arteries, leading to the formation of Charcot-Bouchard microaneurysms, which have a higher susceptibility to rupture. Other causes include acquired or congenital vascular malformations (aneurysms, AVMs), head trauma, brain tumors, coagulopathies, and the use of anticoagulants.

Symptoms vary based on the location and extent of the hemorrhage and can include:

Sudden and severe headache
Nausea and vomiting
Altered state of consciousness (lethargy, coma)
Weakness or paralysis on one side of the face and/or body (hemiparesis/hemiplegia)
Language disorders (aphasia/dysarthria) and visual disturbances
Coordination and balance disorders (ataxia)
Epileptic seizures

The onset is usually acute, with rapid progression of symptoms.

Clinical evaluation: complete neurological examination and detailed medical history.

Neuroimaging:
- Computed Tomography (CT): first-choice examination to identify the presence and extent of the hemorrhage.
- Magnetic Resonance Imaging (MRI): useful for evaluating hemorrhages, especially in the subacute or chronic phase.
- Cerebral vessel studies with CT angiography (CTA) or MR angiography (MRA): necessary to stage the radiological severity of the hemorrhage, its progression, and the presence of any underlying causes.
- Cerebral angiography: in selected cases, to identify vascular malformations or aneurysms.
Laboratory tests: evaluation of coagulation, complete blood count (CBC), and other blood parameters.