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At the time the article was created Frank Gaillard had no recorded disclosures.View Frank Gaillard's current disclosures
At the time the article was last revised Henry Knipe had the following disclosures:
- Radiopaedia Events Pty Ltd, Speaker fees (past)
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
These were assessed during peer review and were determined to not be relevant to the changes that were made.View Henry Knipe's current disclosures
Intracranial hemorrhage (ICH) is a collective term encompassing many different conditions characterized by the extravascular accumulation of blood within different intracranial spaces. A simple categorization is based on location:
Alternatively, intracranial hemorrhage can be thought of in terms of the underlying cause, although in most cases the same etiology can result in multiple different patterns of hemorrhage.
CT scan is almost always the first imaging modality used to assess patients with suspected intracranial hemorrhage. Fortunately, acute blood is markedly hyperdense compared to brain parenchyma, and as such usually poses little difficulty in diagnosis (provided the amount of blood is large enough, and the scan is performed early).
CT angiography (CTA) is increasingly used to assess for a vascular underlying cause, particularly in cases of subarachnoid hemorrhage, or intraparenchymal hemorrhage where something in the presentation, demographics of the patient, or location/appearance of bleed make a primary hemorrhage less likely.
Similarly, CT venogram (CTV) can be used to reliably assess for patency of the dural venous sinuses.
MRI is typically requested when an underlying abnormality is being sought, particularly when an underlying tumor is suspected. MRI of hemorrhage can pose some challenges in that the appearance of blood changes depending on the sequence and the time since the hemorrhage and the size and location of the bleed.
Cerebral angiography is usually performed when a vascular abnormality is suspected and the CT/MR angiogram is either normal (and index of suspicion is high) or equivocal, or in cases where further delineation or treatment of an identified abnormality is required.