A Quick Guide to Intracranial Hemorrhages (ICH)

An intracranial hemorrhage (ICH) describes an acute event where there is bleeding inside the cranium (skull).

intracranial hemorrhage quick guide

This is a life-threatening condition and must be treated immediately.

The bleeding pools in the skull and places excess pressure on the brain, which could potentially lead to brain damage or even death.

Signs and symptoms of intracranial hemorrhages

Knowing the key signs and symptoms of an ICH is essential so that you know when to get medical help. Symptoms can vary depending on the location of the bleed.

If you notice any of the following symptoms, you must consult your doctor:

  • Sudden onset of severe headaches and migraines
  • Headaches associated with a recent head injury
  • Confusion
  • Difficult swallowing
  • Lethargy and drowsiness
  • Seizures
  • Temporary loss of vision
  • Weakness or numbness down one side of the body 
  • Weakness or numbness in the face, legs, or arms

Types of intracranial hemorrhages

There are four main types of ICHs:

Intracerebral hemorrhages

This is the most common type of ICH that causes bleeding inside your brain. Typically, this results from a stroke, and is not often associated with injury.

Subarachnoid hemorrhages

This describes bleeding between the brain and the meninges (the tissues that covers the brain), most commonly caused by trauma to the head.

Epidural hematomas

When blood collects outside one of your brain’s blood vessels between your skull and the outermost layer of your brain, this is known as an epidural hematoma. These usually occur following a severe head injury.

Subdural hematomas

Subdural hematomas are pools of blood that collect on the surface of your brain. These can occur due to rapid movement of the head backward and forward, such as during a car accident.

This type of intracranial hemorrhage is more common in the elderly but it can be seen in children, especially those who have suffered from child abuse.

    What are the risk factors and causes of intracranial hemorrhages?

    There are certain risk factors that increase your chances of ICH, including:

    • Family history of ICH
    • Hypertension (high blood pressure)
    • Excessive physical exertion
    • Smoking
    • Alcohol abuse
    • Drug abuse
    • Chronic kidney disease (CKD)

    If your parents or grandparents suffered from ICH, your chances of experiencing the same is higher. This indicates that there is a hereditary component to ICH. However, there are a lot of environmental factors that also contribute to ICH, such as:

    • Long-term hypertension that may cause the small blood vessels in your brain to burst
    • Head trauma that results in skull fractures or damage to the brain’s arteries
    • Anti-coagulant (blood-thinning) medications that are used to reduce the risk of blood clots, heart attacks, and stroke
    • Bleeding disorders, such as hemophilia or sickle cell anemia
    • Aneurysm where there is a bulge in one of the arteries
    • Brain tumors that can cause bleeding in the brain
    • Excessive drug use, including alcohol, cocaine, and ecstasy

    Unfortunately, ICH can also occur spontaneously with no specific identified cause.

    Who is most likely to affected by an intracranial hemorrhage?

    Although the incidence of intracerebral hemorrhages have decreased over the past decade, it is still twice as common as subarachnoid hemorrhage. It accounts for 10% of strokes, but results in a larger proportion of stroke-related fatalities. Its rate of fatality is 40% at one month and 54% at one year.

    ICH is more common amongst men than women, especially those of Asian descent. Although it is more common in older individuals, there is an increased incidence of ICH in young and middle-aged Japanese and African American individuals.

    For obvious reasons, ICH affects those who have one or more of the risk factors mentioned above more than those without.

    How is an intracranial hemorrhage diagnosed?

    Diagnoses of ICH always begins with doctors taking a scan of your brain. Most commonly, this is a computed tomography (CT) scan that takes an x-ray of the brain to show any bleeding.

    The scan might require injection of a contrasting agent into the blood to view the arteries of the brain. A small flexible tube, known as a catheter, is inserted into an artery to allow the contrasting agent to enter the bloodstream.

    Magnetic resonance imaging (MRI) may also be used to view the brain. This type of scan uses a magnetic field and radio waves to visualize the soft tissues in your brain.

    What are the treatment options for an intracranial hemorrhage?

    The specific treatment options depend on the cause of the ICH. They can be life-saving treatments or management options that relieve symptoms and prevent further complications.

    Once the cause of the ICH and the area of the brain that is affected have been identified, doctors will formulate a personalized treatment plan based on the patient’s needs. This can involve medical and surgical treatment options.

    Certain medications may be helpful, including:

    • Anticoagulants to reduce the risk of blood clotting
    • Medications to reduce the effects of blood-thinning medications
    • Steroids to reduce swelling around the brain
    • Anti-seizure medications if the hemorrhage has resulted in uncontrollable seizures

    The specific medications that are given depend on the patient’s risk factors and the cause of the ICH.

    Doctors may also reduce swelling and pressure in the brain by drilling a small hole in the skull to remove excess blood or hematomas (blood clots). They might also remove some of the cerebrospinal fluid (CSF) from the ventricles of the brain to reduce pressure.

    It’s likely that you will require long-term care following an ICH. This can include long-term medications, regular check-ups and scans, and ongoing physical therapy sessions.

    How can intracranial hemorrhages be avoided?

    Although some cases of ICH occur spontaneously, there are certain things that can be done to reduce the risk of ICH.

    • Reduce the risk of head trauma by driving safely and wearing a helmet when you’re on a motorcycle
    • Avoid situations where the risk of falling is high
    • Avoid smoking
    • Avoid excessive alcohol or drug use
    • Exercise regularly for weight and blood pressure management, but avoid over exertion

    Have any questions, or want to get in touch with our Southern California radiology team? Give us a call, or schedule an appointment with our expert radiologists today!


    [1] https://pubmed.ncbi.nlm.nih.gov/15344894/

    [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113463/ 

    [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307940/