An intracerebral hemorrhage (also called a brain hemorrhage or a cerebral hemorrhage) is a dangerous disease that occurs when a blood vessel within the brain bursts, causing the blood to leak inside the brain. The Mount Sinai Health System has developed one of the first intracerebral hemorrhage (ICH) centers in the world. Our multidisciplinary cerebrovascular team of endovascular surgeons, neurosurgeons, neuro-intensivists, neurologists, pediatric intensivists, physiatrists, nurses, physician assistants, physical therapists, and speech therapists is highly specialized and experienced in the evaluation and treatment of ICH.

J Mocco, MD, MS, and Christopher P. Kellner, MD. have a developed a minimally invasive procedure using a device called the Apollo System, to evacuate ICH in some patients. Mount Sinai is the main site running a clinical trial that includes many hospitals throughout the country.

Causes of Intracerebral Hemorrhage

Several things can cause intracerebral hemorrhage, including:

• • Hemorrhagic stroke due to hypertension, brain tumors, coagulopathy (patients taking antiplatelet agents or anticoagulants), arteriovenous malformations of the brain, brain aneurysms, and  cerebral amyloid angiopathy
  • Epidural hemorrhage due to head trauma
  • Subarachnoid hemorrhage caused by brain aneurysms and arteriovenous malformations
  • Subdural hemorrhage caused by head trauma
  • Intraventricular hemorrhage caused by hypertension, brain aneurysms, and/or arteriovenous malformations 

Factors that increase the risk for brain hemorrhage include:

• Age
• High blood pressure
• Family history of hemorrhage, weak blood vessels, aneurysms, or arteriovenous malformations
• Brain tumors
• Smoking/alcohol abuse
• Use of antiplatelet and anticoagulant therapy
• Head trauma

Some people have an intracerebral hemorrhage without warning. Others experience warning symptoms such as sudden and intense headache, nausea, vomiting, quick onset of numbness or weakness, dizziness, or loss of consciousness.

Diagnosis

If we think you might have had a brain hemorrhage or a condition that might lead to cerebral hemorrhage, our doctors can test for the condition. We use tests such as:

• Computed tomography (CT) scan
• Magnetic resonance imaging and magnetic resonance angiography, which use magnetic field and radio waves to produce highly accurate, cross-section views of the body's interior
• Lumbar puncture (spinal tap)
• Cerebral angiography, which uses dye and X-rays to see how blood is flowing in your brain

Treatment Options

Treatment decisions for ICH depend predominantly on whether there is an underlying lesion. First, we perform studies such as CT angiogram, magnetic resonance imaging, and possibly an angiogram to identify a cause for the bleeding. If there is no underlying lesion, we may be able to remove the blood with a minimally invasive evacuation through a 1 cm incision and burr hole with an endoscopic camera and suction device called the Apollo System. Mount Sinai is the principle site in a multicenter clinical trial evaluating if and how much this procedure helps patients with this disease.