• Macrovascular lesions, such as arterial aneurysms, underlie 10-15% of spontaneous intracerebral hemorrhage.
• Early identification of such abnormalities is important to allow appropriate treatment.
• Specific features on non contrast CT of an underlying macrovascular lesion include enlarged vessels or calcifications along margins of ICH 1.
• Subarachnoid hemorrhage in the basal cisterns and ICH location adjacent to the circle of Willis are other risk factors for an underlying macrovascular lesion.

This case also highlights consequences of raised intracranial pressure including brain herniation.

The patient was too agitated to undergo CT angiography at the time of the diagnostic CT, and died shortly later.