![]() 5 AHT may also be an acute cause of ICH by affecting small arterioles that are at risk due to hypertrophy of their walls. ![]() This in turn causes the lacunar infarcts, leukoaraiosis, and vascular rupture that are responsible for the appearance of ICH. Chronic AHT provokes degenerative changes in arteriole walls that favour vascular obstructions. The most important risk factor for developing ICH in all age groups and both sexes is AHT, whether systolic or diastolic. However, the higher incidence rate among the elderly may also contribute to the decrease in mortality recorded in recent years, because of more pronounced cerebral atrophy. This is related to the ageing of the population. The incidence of ICH is on the rise despite improved control over certain risk factors. If initial volume is less than 30 cm 3, mortality rates are 39% for deep haemorrhages, 7% for lobar haemorrhages, and 57% for cerebellar haemorrhages. In patients with an initial haemorrhage volume greater than 60 cm 3, mortality for deep haemorrhages is 93%, and for lobar haemorrhages, 72%. 4 Mortality at 30 days is related to the size and location of the ICH. 3 Most deaths occur in the first 2 days, and only 20% of the total patients are independent 6 months after having had an ICH. The mortality rate during the first month after ICH is 40.4%. 2 While ICH is only present in 10% to 15% of all strokes, it is associated with a poorer prognosis and higher morbidity and mortality rates. In Europe, its incidence rate is approximately 15 cases per 100 000 inhabitants. ICH incidence varies by country, race, age, and sex, and it is closely related to AHT prevalence. They are associated with such entities as tumours, arteriovenous malformations (AVM), coagulation disorders, substance abuse, or haemorrhages inside areas of ischaemia. ![]() Secondary ICHs are caused by the rupture of blood vessels that are congenitally abnormal or newly formed, or of vessels that contain vascular wall abnormalities or weaknesses caused by coagulation disorders. Primary ICHs are the most common and they are caused by the rupture of any blood vessel within the brain's normal vascular system after the vascular wall is weakened by degenerative processes secondary to arterial hypertension (AHT) or amyloid angiopathy. Haemorrhages are categorised as primary or secondary depending on the cause of the bleed. This trait distinguishes ICH from subarachnoid haemorrhage and primary intraventricular haemorrhage. Although the bleed may leak into the ventricular system or the subarachnoid space, it always begins in brain tissue. Intracerebral haemorrhage (ICH) refers to the collection of blood within the cerebral parenchyma as the result of vascular rupture unrelated to trauma. ![]()
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