Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Intracerebral Hemorrhage

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In one line

·A blood vessel inside the brain bursts and bleeds into the brain tissue itself.

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Normal physiology

·The brain sits inside a hard skull and is fed by a network of arteries that branch smaller and smaller, bringing oxygen and sugar to every brain cell. These vessels have strong, elastic walls that handle the pulse of blood pressure without leaking.

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What goes wrong

·A small artery deep in the brain or near the surface bursts, and blood leaks out into the brain tissue. Instead of feeding cells, the blood becomes a growing clot that squashes and kills the brain around it.

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Hallmark signs

·Sudden weakness or numbness on one side of the body
·Severe headache that comes on suddenly
·Trouble speaking or understanding words (aphasia)
·Sudden vision problems (blurred vision, double vision, or loss of part of the visual field)
·Loss of balance or trouble walking
·Nausea and vomiting
·Confusion or difficulty staying awake (altered level of consciousness)
·Seizures

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Red flags · escalate now

·Sudden, severe headache described as 'the worst headache of my life'
·Rapid worsening of confusion, weakness, or loss of consciousness
·Seizure in someone with no prior seizure history
·Signs of brainstem injury: trouble breathing, very slow or irregular heartbeat, or pupils that do not respond to light
·Symptoms appearing suddenly in someone taking blood thinners (anticoagulants or antiplatelet drugs)

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Workup

·Non-contrast head CT
·Complete blood count (CBC) with platelet count
·PT/INR and aPTT
·Basic metabolic panel (BMP)
·CT angiography (CTA) of the head
·Electrocardiogram (ECG)

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Treatment

·Lower systolic blood pressure to under 140 mmHg using IV nicardipine or clevidipine
·Reverse blood thinners: give vitamin K and prothrombin complex concentrate (PCC) for warfarin, idarucizumab for dabigatran, or andexanet alfa for rivaroxaban or apixaban
·Manage intracranial pressure: elevate head of bed to 30 degrees, give mannitol (0.25–1 g/kg IV) or 3% hypertonic saline, sedate if agitated, and consider an ICP monitor if GCS ≤8
·Surgical evacuation if cerebellar bleed is larger than 3 cm, or lobar bleed larger than 30 mL that is getting worse; insert external ventricular drain (EVD) if hydrocephalus develops
·Give levetiracetam 500–1000 mg IV twice daily for lobar hemorrhages to prevent seizures
·Avoid platelet transfusion unless platelet count is below 50,000 or urgent surgery is planned; avoid preventive (prophylactic) antiepileptics if no seizure occurred

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NCLEX trap

·STOP all blood thinners right away in intracerebral bleeding (hemorrhage). Blood thinners will make the bleeding inside the brain worse. Give reversal medicines instead: vitamin K and prothrombin complex concentrate (PCC) for warfarin, idarucizumab for dabigatran, or andexanet alfa for rivaroxaban or apixaban. The goal is to stop the bleed from growing.
·Lower blood pressure carefully to less than 140 systolic in intracerebral bleeding (hemorrhage). If you drop it too fast, you will cut off the blood supply to the healthy brain tissue around the bleed and cause more damage. The guideline target is systolic BP less than 140 within the first hour, using IV medicines like nicardipine or labetalol.
·In intracerebral bleeding (hemorrhage), do NOT overload with fluids—this makes brain swelling worse. Keep the patient euvolemic (normal fluid balance). Raise the head of the bed 30 degrees to help drain fluid from the brain. Give mannitol or hypertonic saline (3% NaCl) ONLY if intracranial pressure (ICP) stays dangerously high (over 20–22 mmHg) despite other measures. These are救命 (rescue) moves, not routine.
·Watch closely for the bleed to expand or brain swelling to worsen in intracerebral bleeding (hemorrhage). If the blood clot is bigger than 3 cm in the cerebellum (the back lower brain that controls balance and breathing), or if a large lobar bleed (in the outer brain) gets worse and the patient is deteriorating, emergency surgery to drain the blood is life-saving, not optional. Sedation alone will not fix rising pressure.
·In intracerebral bleeding (hemorrhage), sudden severe headache and vomiting mean pressure is rising inside the skull. They are danger signs of increased intracranial pressure, not just symptoms to cover up. You must treat the cause—the rising pressure—with measures like head elevation, BP control, possible osmotic therapy, and monitoring for signs of herniation (the brain being pushed down). Do not just mask the pain.
·In intracerebral bleeding (hemorrhage), even small bleeds can expand rapidly in the first 3–6 hours. Admit EVERY patient to the ICU or stroke unit for close neuro checks, repeat CT imaging in 6–12 hours, and continuous blood pressure monitoring. Brain swelling peaks around 24–72 hours and can turn a small bleed deadly. Early discharge is dangerous.

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