Intracerebral Hemorrhage (ICH)

What is ICH?

Bleeding within the brain tissue, commonly due to hypertension, amyloid angiopathy, or anticoagulation. Non-contrast CT is first-line.

Imaging Appearance

• Hyperdense collection in basal ganglia, lobar, thalamic, or cerebellar regions
• Perihematomal edema, mass effect, midline shift
• Intraventricular extension raises hydrocephalus risk

Clinical Significance

• Rapid assessment determines ICU care, BP control, surgery consideration
• Hematoma expansion risk highest in first hours

Symptoms

• Sudden focal deficit, severe headache, vomiting, decreased consciousness

Diagnosis

• Non-contrast head CT
• Labs: renal/electrolytes for contrast planning or BP meds

Treatment

• BP management, reverse anticoagulation, neurosurgical consult
• Surgical evacuation for select lobar or cerebellar bleeds

Prognosis

• Depends on volume, age, GCS; early care improves outcomes

What Should You Do?

1. Activate stroke/ICH emergency pathway.
2. Avoid anticoagulants/antiplatelets until cleared.
3. Monitor neuro status closely.

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Medical Disclaimer: Educational only; follow neurologist/neurosurgeon guidance.