Spontaneous intracranial haemorrhage

Intracranial haemorrhage, the pathological accumulation of blood within the cranial vault, may occur within brain parenchyma or the surrounding meningeal spaces and is most commonly caused by trauma. Spontaneous intracranial haemorrhage generally occurs within the subarachnoid (SAH), intracerebral (ICH) and intraventricular (IVH) spaces. SAH usually occurs as a result of aneurysmal rupture and happens with an annual incidence of 10/100 000 population. Non-traumatic ICH accounts for 8–13% of all strokes and results from a wide spectrum of disorders. However it most commonly results from hypertensive damage to blood vessel walls (e.g., hypertension, eclampsia, drug abuse). ICH is more likely to result in death or major disability than ischaemic stroke or SAH.Symptoms vary depending on the location of the bleed and the amount of brain tissue affected. The symptoms usually develop suddenly and without warning, although they may occasionally develop in a stepwise, episodic manner or they may get progressively worse, either as a result of further haemorrhage (a particular risk in aneurysmal SAH) or the development of oedema surrounding a focal haematoma. The presence of blood within the ventricular system also predisposes the patient to deterioration from secondary hydrocephalus. This may be of acute onset but may also develop much more insidiously.Management is generally supportive. The identification of any underlying structural vascular abnormality, particularly when an intracranial aneurysm is suspected, is important, allowing early treatment and the prevention of rehaemorrhage.