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Intracerebral haemorrhage

Nature Reviews Disease Primers volume 9, Article number: 14 (2023) Cite this article

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Abstract

Intracerebral haemorrhage (ICH) is a dramatic condition caused by the rupture of a cerebral vessel and the entry of blood into the brain parenchyma. ICH is a major contributor to stroke-related mortality and dependency: only half of patients survive for 1 year after ICH, and patients who survive have sequelae that affect their quality of life. The incidence of ICH has increased in the past few decades with shifts in the underlying vessel disease over time as vascular prevention has improved and use of antithrombotic agents has increased. The pathophysiology of ICH is complex and encompasses mechanical mass effect, haematoma expansion and secondary injury. Identifying the causes of ICH and predicting the vital and functional outcome of patients and their long-term vascular risk have improved in the past decade; however, no specific treatment is available for ICH. ICH remains a medical emergency, with prevention of haematoma expansion as the key therapeutic target. After discharge, secondary prevention and management of vascular risk factors in patients remains challenging and is based on an individual benefit–risk balance evaluation.

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Fig. 1: Epidemiology of intracerebral haemorrhage.
Fig. 2: Examples of intracerebral haemorrhage associated with deep perforating vasculopathy and probable cerebral amyloid angiopathy.
Fig. 3: Clues for underlying treatable causes of intracerebral haemorrhage.
Fig. 4: Putative secondary injury and adaptive process following intracerebral haemorrhage and potential therapeutic targets.
Fig. 5: Mechanisms involved in the pathophysiology of intracerebral haemorrhage.
Fig. 6: Imaging markers of haematoma expansion.
Fig. 7: Representative example of advanced imaging to determine the cause of intracerebral haemorrhage.

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Acknowledgements

The authors thank G. Boulouis for his assistance for Fig. 6.

Author information

Authors and Affiliations

  1. Lille Neuroscience & Cognition (LilNCog) - U1172, University of Lille, Inserm, CHU Lille, Lille, France

    Laurent Puy & Charlotte Cordonnier

  2. Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust & University of Manchester, Manchester, UK

    Adrian R. Parry-Jones

  3. Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    Adrian R. Parry-Jones

  4. Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK

    Adrian R. Parry-Jones

  5. Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway

    Else Charlotte Sandset

  6. The Norwegian Air Ambulance Foundation, Oslo, Norway

    Else Charlotte Sandset

  7. Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

    Dar Dowlatshahi

  8. Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Wendy Ziai

  9. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Wendy Ziai

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Contributions

Introduction (L.P. and C.C.); Epidemiology (L.P.); Mechanisms/pathophysiology (A.R.P.-J. and L.P.); Diagnosis, screening and prevention (D.D. and L.P.); Management (E.C.S., W.Z., A.RP.-J., L.P. and C.C.); Quality of life (L.P. and D.D.); Outlook (D.D. and C.C.); Overview of Primer (C.C.).

Corresponding author

Correspondence to Charlotte Cordonnier.

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Competing interests

L.P. received speaker fees from Daichi–Sankyo. A.R.P.-J. participated in advisory boards for and received speaker’s fees from Alexion Pharmaceuticals, Inc. E.C.S. is on the steering committee of ANNEXAi. D.D. holds a patent for the CARL software to automatically detect contrast extravasation, has received honoraria from AstraZeneca Canada, is on the steering committee of the FASTEST and ENRICH-AF trials. W.Z. is supported by the NIH (1U01NS080824, R01NS102583, U01NS106513 and 1R01NS120557). C.C. received speaker fees from BMS and Pfizer.

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Nature Reviews Disease Primers thanks G. Donnan, J. Kuramatsu, L. P. Liu and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Puy, L., Parry-Jones, A.R., Sandset, E.C. et al. Intracerebral haemorrhage. Nat Rev Dis Primers 9, 14 (2023). https://doi.org/10.1038/s41572-023-00424-7

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