Intracerebral hemorrhage (ICH) is spontaneous nontraumatic bleeding into the brain parenchyma. Annually, approximately 65,000 people in the United States suffer an ICH, which accounts for 10–30% of all stroke cases across different ethnic groups. ICH is the most fatal and least treatable form of stroke, causing, in addition, severe disability among survivors. Patients with ICH uniformly require ICU management and patients cared for in specialized neurologic intensive care units are less likely to die. Although, as compared to ischemic stroke and subarachnoid hemorrhage, the pace of advances in management of ICH has been slow, recent results of clinical trials of recombinant factor VIIa (fVIIa) in acute ICH 9 have generated excitement.

Based on the underlying pathology of ruptured vessel that originates the bleeding, ICH is classified as primary or secondary. Th e majority of primary ICH result from a ruptured vessel as a consequence of chronic injury to the small cerebral vessels by sustained hypertension (hypertensive vasculopathy) 10 –12 or abnormal protein deposition (cerebral amyloid angiopathy). Secondary causes of ICH include underlying vascular malformations, ruptured saccular aneurysms, coagulation disorders, use of anticoagulants and thrombolytic agents, hemorrhage into a preexisting infarct, brain tumor, or infectious focus, and drug abuse (Table 11.1).

EPIDEMIOLOGY AND RISK FACTORS

ICH is a common disorder that occurs in all populations. Estimates of overall incidence are 12–15 cases per 100,000 people per year, slightly higher among men, young and middle-aged African-Americans, and Asians.