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



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

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Cases and figures

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