Intracerebral hemorrhage

An intracerebral hemorrhage, or intraparenchymal cerebral hemorrhage, is a subset of an intracranial hemorrhage and encompasses a number of entities that have in common the acute accumulation of blood within the parenchyma of the brain. The etiology, epidemiology, treatment and prognosis vary widely depending on the type of hemorrhage, and as such, these are discussed separately. 

They are most often broadly divided according to whether they are spontaneous (primary) or due to an underlying lesion (secondary), and then further divided according to etiology and/or location. 

  1. primary hemorrhages (no underlying lesion)
  2. secondary hemorrhages (some other lesion complicated by hemorrhage)
    • vascular malformation
    • cerebral venous thrombosis
    • tumor (primary or secondary)

Practical points

With any intracerebral hemorrhage the following points should be included in a report as they have prognostic implications 3:

  • location
  • size/volume
    • the ABC/2 formula is widely used, but there may be more accurate formulas (e.g. 2.5ABC/6, SH/2) and analyzes available, some of which, however, may require the addition of specific software to the standard PACS tools
  • shape (irregular vs regular)
  • density (homogeneous vs heterogeneous)
  • presence/absence of substantial surrounding edema that may indicate an underlying tumor
  • presence/absence of intraventricular hemorrhage
  • presence/absence of hydrocephalus
  • when CT angiography is performed, the presence/absence of the CTA spot sign or a vascular malformation

Video

 

Stroke and intracranial haemorrhage

Article information

rID: 6132
Synonyms or Alternate Spellings:
  • Intraparenchymal hematoma
  • Intracerebral bleed
  • Intracerebral hemorrhage
  • Haemorrhagic stroke
  • Intraparenchymal cerebral haemorrhage
  • Intraparenchymal cerebral bleed
  • Intraparenchymal cerebral hemorrhage
  • Intracerebral haemorrhages
  • Intraparenchymal cerebral hemorrhages
  • Intraparenchymal cerebral bleeds
  • Intraparenchymal cerebral haemorrhages
  • Intracerebral hemorrhages
  • Intracerebral bleeds
  • Intra-cerebral haemorrhage

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: ICH (on warfarin)
    Drag here to reorder.
  • Case 2: basal ganglial bleed
    Drag here to reorder.
  • Case 3: hemorrhagic infarction
    Drag here to reorder.
  • Case 4: hypertensive hemorrhage
    Drag here to reorder.
  • Case 5
    Drag here to reorder.
  •  Case 6
    Drag here to reorder.
  • Case 7: coagulopathy
    Drag here to reorder.
  • Case 8: subacute intracranial hemorrhage
    Drag here to reorder.
  • Case 9: subacute intracerebral hematoma
    Drag here to reorder.
  • Case 10
    Drag here to reorder.
  • Case 11: cerebellar
    Drag here to reorder.
  • Case 12
    Drag here to reorder.
  • Case 13: T2*
    Drag here to reorder.
  • Case 14: Hyperacute hemorrhage on MRI and CT
    Drag here to reorder.
  • Case 15: spot sign
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.