Intracerebral Hematoma (ICH)

Also called, blood clot in the brain

Cerebral hemorrhage is internal bleeding caused by the bursting of a blood vessel within the brain. This causes bleeding into the brain matter and damage to the surrounding tissue. A cerebral hemorrhage is a life-threatening disorder and may cause either partial or complete paralysis. Most such hemorrhages result from either the rupture of a hardened artery, as may be associated with hypertension (high blood pressure), from weakened blood vessels in a disease state, bleeding disorders, or from trauma to the head.

The blood clot is seen as bright white

The brain is an "end organ." It is also the most energy-hungry organ in the body. Because of these two factors, it constantly demands a disproportionately large percentage of the blood supply from the heart. The brain weighs about 5% of the body's total weight, but constantly uses more than 20% of the body's blood supply to survive. It has both "old parts" and "new parts." As the human species evolved over the ages, some of the less sophisticated parts of the brain remained unchanged; other parts have been modified as humankind progressed along its evolutionary path. Among these unchanged brain parts are the very simple, thin-walled blood vessels that supply one of the oldest parts of the brain, the basal ganglia. This area of the brain is made up of the neurons responsible for things like control of coordination and central relay centers for sensation. Of all the vessels in the body, these are the least prepared to handle chronic, increased blood pressure. At the same time, they are responsible for carrying a larger amount of blood to a very vital area, at relatively high pressures. Thus, over the years, they can develop microscopic out pouchings. When the tiny out pouchings burst, blood enters into the brain at very high pressure, destroying all tissue in its path.

Other Kinds of Intracerebral Hemorrhages
Other hemorrhages include those arising from: arteriovenous malformations, unsuspected tumors, brain vessel diseases due to infection, degenerative diseases such as amyloid angiopathy, drug useage (intravenous, amphetamine or cocaine usage), or blood thinner therapies (e.g. coumadin or heparin treatment for heart disease).

Treatment
Until recently, ICH had been treated with watchful waiting, except for those cases where the size of the hemorrhage absolutely demanded surgery. The brain will eventually absorb the blood over time (three weeks to 2 months). This may still be the best approach in many cases. However, with the advent of improved surgical techniques, localizing imaging capabilities, and better understanding, a move to early surgical removal or decompression has been the trend.

Better Understanding
Even if the high pressure blood hadn't cut a path of brain destruction, the shear mass of the blood within the brain and the tight confines of the skull could be responsible for continuing damage to surrounding brain tissues. To minimize further destruction, therefore, it makes sense to reduce the local pressure by decompressing such brain tissues through the removal of most of the blood clot, whenever possible.

Improved Imaging Capabilities
No matter how deep and unseen the blood clot, new imaging techniques allow the surgeon to target and see exactly where he needs to go when removing a blood clot. Stereotactic machinery and real-time intra-operative ultrasound guidance systems have helped tremendously, practically eliminating the downside of surgery.

Improved Surgical Techniques
Smaller openings, better surgical accuracy, improved lighting, and the simplicity of needle aspiration techniques lessen the danger of brain surgery for ICH. It is now reasonable to remove any and all brain hemorrhages of significant size very soon after the patient has arrived at the hospital. This new approach has become a part of the "acute care" treatment application to Brain Attack victims. Over the past few years, the medical community has come to consider ICH a near emergency and treated as such. Your doctor will explain "acute care" treatment early, in the hopes of salvaging undamaged brain when possible.

Delay or Hold on the Surgery
Factors that might delay early removal of an ICH include: stabilization of blood pressure or other medical conditions (e.g. diabetes, clotting abnormalities, liver or kidney failure, heart problems etc.); reversal of medications that prevent blood clotting (e.g. coumadin or aspirin), or Amyloid Disease of the brain. Most often, surgery is not helpful in these instances, and future blood clots could also occur after a relatively short interval. Another condition calling for surgical delay could be the extremely poor neurologic state of the patient. Even a small hemorrhage in the wrong place (such as the middle of the brainstem) may be associated with such a poor outlook that surgery would not be of help, or could even result in further damage.

Surgery does not reverse the effects of the initial hemorrhage. The exact extent of the damage to the brain may not be known for weeks or months to come. Also, the already injured brain is more likely to hemorrhage again while it is trying to recover. Our efforts after surgery are to keep the pressure in the head in the normal range, assure adequate oxygenation to the brain, prevent or treat infection, and prevent other system failures.

Links:

Brain & Neurosurgery Information Center

Mayo Clinic

Virtual Brain

Glossary of Tests