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Related Concept Videos

Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
Cerebral Edema l: Introduction01:19

Cerebral Edema l: Introduction

Cerebral edema is a pathological increase in brain water content that disrupts intracranial pressure regulation and impairs neurological function. Because the cranial vault is rigid, even modest increases in tissue volume can compromise cerebral perfusion, distort neural structures, and initiate secondary injury. Cerebral edema develops through four principal mechanisms: vasogenic, cytotoxic, interstitial, and ionic.Vasogenic EdemaVasogenic edema arises from disruption of the blood–brain...

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Updated: May 26, 2026

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
09:01

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Published on: October 15, 2021

Intracranial hemorrhage.

Andrew M Naidech1

  • 1Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. a-naidech@northwestern.edu

American Journal of Respiratory and Critical Care Medicine
|December 15, 2011
PubMed
Summary

Intensive care improves outcomes for patients with intracranial hemorrhage (bleeding in the brain). Critical care focuses on managing blood pressure, coagulopathy, and neurological injury to enhance recovery.

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Neurosurgery

Background:

  • Intracranial hemorrhage (ICH) is a critical condition with significant mortality.
  • Causes of ICH include spontaneous bleeding, vascular malformations, trauma, and anticoagulation.
  • Effective management in intensive care units (ICUs) can improve patient outcomes.

Purpose of the Study:

  • To outline the critical care management of intracranial hemorrhage.
  • To discuss the assessment and treatment of neurological injury and associated complications.
  • To highlight factors influencing functional recovery and mortality.

Main Methods:

  • Assessment of ICH etiology and neurological injury severity using bedside scales and computed tomography (CT) scans.
  • Management strategies including blood pressure control, coagulopathy correction, and obliteration of high-risk vascular lesions.

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  • Anticipation and management of secondary complications like myocardial stunning, pulmonary edema, and fever.

    • Main Results:

    • Bedside scales and CT interpretation aid in assessing neurological injury severity.
    • Blood pressure control and coagulopathy correction are key to minimizing hemorrhage expansion.
    • Secondary complications such as myocardial stunning, pulmonary edema, and fever are common but manageable.
    • Goals of care, including do-not-resuscitate status, significantly impact predicted mortality.

    Conclusions:

    • Intensive care is crucial for improving outcomes in patients with intracranial hemorrhage.
    • Comprehensive management addressing the cause, hemorrhage expansion, and secondary complications is essential.
    • Functional recovery is a long-term process, and goals of care discussions are vital for patient management and prognosis.