Intracerebral hemorrhage (ICB) – colloquially called cerebral hemorrhage – (synonyms: apoplectic hemorrhage; apoplectic hemorrhage; apoplectic cerebral mass hemorrhage; encephalorrhage; cerebral hemorrhage; hemorrhagic encephalomalacia; hemorrhagic apoplexy; intracerebral hemorrhage; intracerebral hematoma; IZB; parenchymal hemorrhage; ICD-10-GM I61. -: Intracerebral hemorrhage) is bleeding into the brain parenchyma (brain substance, brain tissue) or into the cerebrospinal fluid (CSF) space (system of cavities in/around the brain) caused by rupture (rupture) of vessels running in the brain parenchyma. Intracerebral hemorrhage often occurs suddenly. In most cases, a large part of the brain is affected, in which case it is called a cerebral mass hemorrhage. A hematoma (bruise) forms as a result of the cerebral hemorrhage. Intracerebral hemorrhage belongs to intracranial hemorrhage (brain hemorrhage inside the skull) and should be distinguished from extracerebral hemorrhage (outside the brain) such as epidural hematoma, subdural hematoma and subarachnoid hemorrhage (SAB). Intracerebral hemorrhage is also called hemorrhagic apoplexy (stroke due to cerebral hemorrhage), which presents with similar symptoms to ischemic apoplexy (stroke due to vascular occlusion) but differs in treatment.Intracerebral hemorrhage accounts for about 15% of all strokes. Intracerebral hemorrhage is divided causally into traumatic and nontraumatic hemorrhage. The most common causes of intracerebral hemorrhage are arterial hypertension or the resulting changes in small blood vessels and arteriovenous malformations (AVM) of the brain. In addition, intracerebral hemorrhage is a feared complication of anticoagulant/anticoagulant therapy. Intracerebral hemorrhages (ICBs) in which no other cause besides arterial hypertension is found are referred to as “spontaneous ICBs.” Sex ratio: men are more commonly affected than women. Frequency peak: risk increases with age. Worldwide, about 1 million people suffer an intracerebral hemorrhage per year; in Europe, there are about 90,000 people, of whom about 30,000 live in Germany. The incidence (frequency of new cases) is about 20 cases per 100,000 inhabitants per year (in Germany). Worldwide, the incidence is increasing. Course and prognosis: Intracerebral hemorrhage always represents a medical emergency! Since it is not possible to distinguish intracerebral hemorrhage (hemorrhagic apoplexy) from ischemic apoplexy in the prehospital phase, thrombolysis (dissolution of a thrombus with the help of drugs (fibrinolytics)) or anticoagulants (anticoagulants) must not be given initially. In the clinic, an imaging procedure, usually a computed tomography of the skull (cranial computed tomography, cCT), must be performed immediately in order to initiate adequate therapy after the diagnosis has been made. The prognosis of an intracerebral hemorrhage depends on various factors. Above all, the size of the hemorrhage and its localization play a decisive role. Other prognostic parameters include the patient’s age, neurologic status, and hematoma progression (progression of hemorrhage; synonyms: hematoma growth; hematoma expansion). If the hemorrhage breaks into the ventricular system (cavity system in the brain) (intraventricular hemorrhage (IVB)), which is considered an independent risk factor, there may be disturbances in the circulation of cerebrospinal fluid (CSF), colloquially “nerve fluid”) – the prognosis is then unfavorable.The brain damage caused by intracerebral hemorrhage can only be treated to a limited extent. The main focus is on avoiding secondary damage and complications. With regard to lethality (mortality related to the total number of people suffering from the disease), the following can be said:
- One-third die before reaching the hospital
- Another third dies during the inpatient stay or survives with significant deficits
- One third survives, but retains a slight deficit
