Intracranial haemorrhage

Dr Craig Hacking and A.Prof Frank Gaillard et al.

Intracranial haemorrhage (ICH) is a collective term encompassing many different conditions characterised by the extravascular accumulation of blood within different intracranial spaces. A simple categorization is based on location:

Alternatively, intracranial haemorrhage can be thought of in terms of the underlying cause, although in most cases the same aetiology can result in multiple different patterns of haemorrhage.

Radiographic features

CT

CT scan is almost always the first imaging modality used to assess patients with suspected intracranial haemorrhage. 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 haemorrhage, or intraparenchymal haemorrhage where something in the presentation, demographics of the patient or location/appearance of bleed make a primary haemorrhage less likely.

Similarly, CT venogram (CTV) can be used to reliably assess for patency of the dural venous sinuses.

MRI

MRI is typically requested when an underlying abnormality is being sought, particularly when an underlying tumour is suspected. MRI of haemorrhage can pose some challenges in that the appearance of blood changes depending on the sequence and the time since the haemorrhage and the size and location of the bleed.

Angiography

Cerebral angiography is usually performed when a vascular abnormality is suspected and the CT 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.

Stroke and intracranial haemorrhage
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Article information

rID: 1518
Synonyms or Alternate Spellings:
  • ICH
  • Intracranial hemorrhage
  • Intracranial haemorrhages
  • Intracranial hemorrhages

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Cases and figures

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    Figure 1: appearance on CT by age
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    Figure 2: appearance on MRI by age
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    Chronic subdural ...
    Case 1: chronic SDH
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    CT
    Case 2: EDH
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    Case 3: lobar
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    Case 4: intraventricular
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    NCCT day 0
    Case 5: basal ganglia
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    Case 6: cerebellar haemorrhage
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    Case 7: combination of EDH, SDH & SAH
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    Case 8: combination of IVH, intracerebral & SAH
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    Case 9: bilateral SDH
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    Case 10: Intracranial haemorrhage with fluid-fluid level
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