The immediate effect of intracerebral haemorrhage is one of a space-occupying lesion due to the extravasation of blood into the brain parenchyma. The course depends on factors favouring containment such as increased tissue pressure, and those encouraging enlargement such as decreased coagulability and increased systemic blood pressure. The haematoma may spread along fibre tracts or decompress into a ventricle or into the spinal fluid to the brain surface. Oedema is rarely a prominent feature.
The clinical features usually become evident while patients are physically active and vary according to the function of the site of bleeding. They usually increase over seconds, minutes or rarely hours. A large ICH is associated with increased intracranial pressure and consequently headache, vomiting and decreased level of consciousness. Seizures commonly develop with subcortical haematomas.
Resolution occurs in 4-8 weeks, leaving a cystic cavity.
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