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 usually caused by trauma. In general, spontaneous intracranial haemorrhage occurs within the subarachnoid (SAH), intracerebral (ICH) and intraventricular (IVH) spaces. SAH usually occurs as a result of aneurysmal rupture with an annual incidence of 10 per 100,000 population. Non-traumatic ICH accounts for 8–13% of strokes and results from a wide spectrum of disorders; it usually 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 bleed location and the amount of brain tissue affected. The symptoms usually develop suddenly and without warning; they may occasionally develop in a stepwise, episodic manner or they may get progressively worse, as a result of further haemorrhage (a particular risk in aneurysmal SAH) or the development of oedema surrounding a focal haematoma. Blood within the ventricular system also predisposes to deterioration from secondary hydrocephalus; this may be of acute onset but may also develop much more insidiously.In general, management is supportive. Identification of underlying structural vascular abnormalities (particularly intracranial aneurysms) allows early treatment and the prevention of rehaemorrhage.