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Spontaneous Nontraumatic Intracranial Hemorrhage
Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Primary intraparenchymal hemorrhage (pICH), hemorrhagic stroke
          • Definitions

            • Acute nontraumatic intracranial hemorrhage (ICH)
              • Etiology often initially unknown

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Angiographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Anderson E et al: Prognosis and futility in neurosurgical emergencies: a review. Clin Neurol Neurosurg. 195:105851, 2020
                                          2. Beer-Furlan A et al: Endovascular management of symptomatic intracranial pseudoaneurysm and intimal flow-limiting dissection with a single device. World Neurosurg. ePub, 2020
                                          3. Hoffman H et al: Prediction of mortality after evacuation of supratentorial intracerebral hemorrhage using NSQIP data. J Clin Neurosci. ePub, 2020
                                          4. Ironside N et al: Fully automated segmentation algorithm for perihematomal edema volumetry after spontaneous intracerebral hemorrhage. Stroke. 51(3):815-23, 2020
                                          5. Nawabi J et al: Inter- and intrarater agreement of spot sign and noncontrast CT markers for early intracerebral hemorrhage expansion. J Clin Med. 9(4), 2020
                                          6. Patel VD et al: Natural history of infratentorial intracerebral hemorrhages: two subgroups with distinct presentations and outcomes. J Stroke Cerebrovasc Dis. 104920, 2020
                                          7. Sembolini A et al: Acute hematoma expansion after spontaneous intracerebral hemorrhage: risk factors and impact on long-term prognosis. Neurol Sci. ePub, 2020
                                          8. Wu J et al: Emergency surgery is an effective way to improve the outcome of severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy. Neurosurg Rev. ePub, 2020
                                          9. Ng D et al: The CT swirl sign is associated with hematoma expansion in intracerebral hemorrhage. AJNR Am J Neuroradiol. 39(2):232-7, 2018
                                          10. Rammos SK et al: Aneurysms associated with brain arteriovenous malformations. AJNR Am J Neuroradiol. 37(11):1966-71, 2016
                                          11. Alexander MD et al: Association between venous angioarchitectural features of sporadic brain arteriovenous malformations and intracranial hemorrhage. AJNR Am J Neuroradiol. 36(5):949-52, 2015
                                          12. Kranz PG et al: Spontaneous brain parenchymal hemorrhage: an approach to imaging for the emergency room radiologist. Emerg Radiol. 22(1):53-63, 2015
                                          13. Miller TR et al: Reversible cerebral vasoconstriction syndrome, part 1: epidemiology, pathogenesis, and clinical course. AJNR Am J Neuroradiol. 36(8):1392-9, 2015
                                          14. Sampath Kumar NS et al: Multiple spontaneous hypertensive intracerebral hemorrhages. J Stroke Cerebrovasc Dis. 24(1):e25-7, 2015
                                          15. Ciura VA et al: Nontraumatic acute intraparenchymal hemorrhage: algorithm for workup and differential diagnosis. Semin Roentgenol. 49(1):112-26, 2014
                                          16. Koivunen RJ et al: Predictors of early mortality in young adults after intracerebral hemorrhage. Stroke. 45(8):2454-6, 2014
                                          17. Caceres JA et al: Intracranial hemorrhage. Emerg Med Clin North Am. 30(3):771-94, 2012
                                          18. Gazzeri R et al: Minimal craniotomy and matrix hemostatic sealant for the treatment of spontaneous supratentorial intracerebral hemorrhage. J Neurosurg. 110(5):939-42, 2009
                                          19. Hanley DF: Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage. Stroke. 40(4):1533-8, 2009
                                          20. Jeffree RL et al: Warfarin related intracranial haemorrhage: a case-controlled study of anticoagulation monitoring prior to spontaneous subdural or intracerebral haemorrhage. J Clin Neurosci. 16(7):882-5, 2009
                                          21. Kumar R et al: Spontaneous intracranial hemorrhage in children. Pediatr Neurosurg. 45(1):37-45, 2009
                                          22. Lou M et al: The relationship between hematoma iron content and perihematoma edema: an MRI study. Cerebrovasc Dis. 27(3):266-71, 2009
                                          23. Tejero MA et al: [Multiple spontaneous cerebral haemorrhages. Description of a series and review of the literature.] Rev Neurol. 48(7):346-8, 2009
                                          24. van Beijnum J et al: Outcome after spontaneous and arteriovenous malformation-related intracerebral haemorrhage: population-based studies. Brain. 132(Pt 2):537-43, 2009
                                          25. Walsh M et al: Developmental venous anomaly with symptomatic thrombosis of the draining vein. J Neurosurg. 109(6):1119-22, 2008
                                          26. Harden SP et al: Cranial CT of the unconscious adult patient. Clin Radiol. 62(5):404-15, 2007
                                          27. Chao CP et al: Cerebral amyloid angiopathy: CT and MR imaging findings. Radiographics. 26(5):1517-31, 2006
                                          28. Finelli PF: A diagnostic approach to multiple simultaneous intracerebral hemorrhages. Neurocrit Care. 4(3):267-71, 2006
                                          29. Leach JL et al: Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 26 Suppl 1:S19-41; discussion S42-3, 2006
                                          30. Thanvi B et al: Sporadic cerebral amyloid angiopathy--an important cause of cerebral haemorrhage in older people. Age Ageing. 35(6):565-71, 2006
                                          31. Abilleira S et al: Matrix metalloproteinase-9 concentration after spontaneous intracerebral hemorrhage. J Neurosurg. 99(1):65-70, 2003
                                          32. Fewel ME et al: Spontaneous intracerebral hemorrhage: a review. Neurosurg Focus. 15(4):E1, 2003
                                          33. Kalaria RN et al: Introduction: Non-atherosclerotic cerebrovascular disorders. Brain Pathol. 12(3):337-42, 2002
                                          34. Skidmore CT et al: Spontaneous intracerebral hemorrhage: epidemiology, pathophysiology, and medical management. Neurosurg Clin N Am. 13(3):281-8, v, 2002
                                          35. Qureshi AI et al: Spontaneous intracerebral hemorrhage. N Engl J Med. 344(19):1450-60, 2001
                                          36. Roob G et al: Magnetic resonance imaging of cerebral microbleeds. Curr Opin Neurol. 13(1):69-73, 2000
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Primary intraparenchymal hemorrhage (pICH), hemorrhagic stroke
                                                  • Definitions

                                                    • Acute nontraumatic intracranial hemorrhage (ICH)
                                                      • Etiology often initially unknown

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Angiographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Anderson E et al: Prognosis and futility in neurosurgical emergencies: a review. Clin Neurol Neurosurg. 195:105851, 2020
                                                                                  2. Beer-Furlan A et al: Endovascular management of symptomatic intracranial pseudoaneurysm and intimal flow-limiting dissection with a single device. World Neurosurg. ePub, 2020
                                                                                  3. Hoffman H et al: Prediction of mortality after evacuation of supratentorial intracerebral hemorrhage using NSQIP data. J Clin Neurosci. ePub, 2020
                                                                                  4. Ironside N et al: Fully automated segmentation algorithm for perihematomal edema volumetry after spontaneous intracerebral hemorrhage. Stroke. 51(3):815-23, 2020
                                                                                  5. Nawabi J et al: Inter- and intrarater agreement of spot sign and noncontrast CT markers for early intracerebral hemorrhage expansion. J Clin Med. 9(4), 2020
                                                                                  6. Patel VD et al: Natural history of infratentorial intracerebral hemorrhages: two subgroups with distinct presentations and outcomes. J Stroke Cerebrovasc Dis. 104920, 2020
                                                                                  7. Sembolini A et al: Acute hematoma expansion after spontaneous intracerebral hemorrhage: risk factors and impact on long-term prognosis. Neurol Sci. ePub, 2020
                                                                                  8. Wu J et al: Emergency surgery is an effective way to improve the outcome of severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy. Neurosurg Rev. ePub, 2020
                                                                                  9. Ng D et al: The CT swirl sign is associated with hematoma expansion in intracerebral hemorrhage. AJNR Am J Neuroradiol. 39(2):232-7, 2018
                                                                                  10. Rammos SK et al: Aneurysms associated with brain arteriovenous malformations. AJNR Am J Neuroradiol. 37(11):1966-71, 2016
                                                                                  11. Alexander MD et al: Association between venous angioarchitectural features of sporadic brain arteriovenous malformations and intracranial hemorrhage. AJNR Am J Neuroradiol. 36(5):949-52, 2015
                                                                                  12. Kranz PG et al: Spontaneous brain parenchymal hemorrhage: an approach to imaging for the emergency room radiologist. Emerg Radiol. 22(1):53-63, 2015
                                                                                  13. Miller TR et al: Reversible cerebral vasoconstriction syndrome, part 1: epidemiology, pathogenesis, and clinical course. AJNR Am J Neuroradiol. 36(8):1392-9, 2015
                                                                                  14. Sampath Kumar NS et al: Multiple spontaneous hypertensive intracerebral hemorrhages. J Stroke Cerebrovasc Dis. 24(1):e25-7, 2015
                                                                                  15. Ciura VA et al: Nontraumatic acute intraparenchymal hemorrhage: algorithm for workup and differential diagnosis. Semin Roentgenol. 49(1):112-26, 2014
                                                                                  16. Koivunen RJ et al: Predictors of early mortality in young adults after intracerebral hemorrhage. Stroke. 45(8):2454-6, 2014
                                                                                  17. Caceres JA et al: Intracranial hemorrhage. Emerg Med Clin North Am. 30(3):771-94, 2012
                                                                                  18. Gazzeri R et al: Minimal craniotomy and matrix hemostatic sealant for the treatment of spontaneous supratentorial intracerebral hemorrhage. J Neurosurg. 110(5):939-42, 2009
                                                                                  19. Hanley DF: Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage. Stroke. 40(4):1533-8, 2009
                                                                                  20. Jeffree RL et al: Warfarin related intracranial haemorrhage: a case-controlled study of anticoagulation monitoring prior to spontaneous subdural or intracerebral haemorrhage. J Clin Neurosci. 16(7):882-5, 2009
                                                                                  21. Kumar R et al: Spontaneous intracranial hemorrhage in children. Pediatr Neurosurg. 45(1):37-45, 2009
                                                                                  22. Lou M et al: The relationship between hematoma iron content and perihematoma edema: an MRI study. Cerebrovasc Dis. 27(3):266-71, 2009
                                                                                  23. Tejero MA et al: [Multiple spontaneous cerebral haemorrhages. Description of a series and review of the literature.] Rev Neurol. 48(7):346-8, 2009
                                                                                  24. van Beijnum J et al: Outcome after spontaneous and arteriovenous malformation-related intracerebral haemorrhage: population-based studies. Brain. 132(Pt 2):537-43, 2009
                                                                                  25. Walsh M et al: Developmental venous anomaly with symptomatic thrombosis of the draining vein. J Neurosurg. 109(6):1119-22, 2008
                                                                                  26. Harden SP et al: Cranial CT of the unconscious adult patient. Clin Radiol. 62(5):404-15, 2007
                                                                                  27. Chao CP et al: Cerebral amyloid angiopathy: CT and MR imaging findings. Radiographics. 26(5):1517-31, 2006
                                                                                  28. Finelli PF: A diagnostic approach to multiple simultaneous intracerebral hemorrhages. Neurocrit Care. 4(3):267-71, 2006
                                                                                  29. Leach JL et al: Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 26 Suppl 1:S19-41; discussion S42-3, 2006
                                                                                  30. Thanvi B et al: Sporadic cerebral amyloid angiopathy--an important cause of cerebral haemorrhage in older people. Age Ageing. 35(6):565-71, 2006
                                                                                  31. Abilleira S et al: Matrix metalloproteinase-9 concentration after spontaneous intracerebral hemorrhage. J Neurosurg. 99(1):65-70, 2003
                                                                                  32. Fewel ME et al: Spontaneous intracerebral hemorrhage: a review. Neurosurg Focus. 15(4):E1, 2003
                                                                                  33. Kalaria RN et al: Introduction: Non-atherosclerotic cerebrovascular disorders. Brain Pathol. 12(3):337-42, 2002
                                                                                  34. Skidmore CT et al: Spontaneous intracerebral hemorrhage: epidemiology, pathophysiology, and medical management. Neurosurg Clin N Am. 13(3):281-8, v, 2002
                                                                                  35. Qureshi AI et al: Spontaneous intracerebral hemorrhage. N Engl J Med. 344(19):1450-60, 2001
                                                                                  36. Roob G et al: Magnetic resonance imaging of cerebral microbleeds. Curr Opin Neurol. 13(1):69-73, 2000