intracerebral hemorrhage

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alter kortikaler Hirninfarkt rechts hochfrontal mit geringer Hämorrhagie. MRT T1 koronar. Man erkennt das Infarktareal leicht hypointens und darin schlierenartig eine Hyperintensität, die dem ausgetretenen Blut entspricht (Pfeil).
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CT-scan of a
frontal intracerebral hemorrhage on the right (left image side) as a contre coup. There is dens suture material visible left occipital in the skin.
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MRI-scan (T2*
Haem) of a frontal intracerebral hemorrhage on the right (left image side) as a contre coup.
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MRI-scan (T1)
of a frontal intracerebral hemorrhage on the right (left image side) as a contre coup.
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Comparison of
conventional gradient echo T2*-weighted image (left, TE=20ms), susceptibility weighted image (SWI) and SWI phase image (center and right, respectively, TE=40ms) at 1.5 Tesla. Low signal foci in cerebral amyloid angiopathy (CAA) is shown.
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Comparison of
conventional gradient echo image (GRE) with TE=20 ms (left) and susceptibility weighted image (SWI) with TE=40 ms (right) collected at 1.5 Tesla. Subject shows hemorrhage from trauma.
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Newborn who
is on ECMO after cardiac surgeryCoronal US of the brain (below) shows echogenic material in right subdural space. Coronal and sagittal US of the brain (above) shows a right parietal round mixed echogenicity lesion.The diagnosis was subdural hematoma on ECMO and intracerebral hemorrhage on ECMO.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
congenital diaphragmatic hernia on ECMOCoronal and sagittal US of the brain shows a large, round echogenic lesion in the left parietal lobe.The diagnosis was intracerebral hemorrhage on ECMO.
pediatricimaging.org • CC-by-nc-sa 4.0
Blood -Fluid
Level in a Spontaneous Intraparenchymal hematoma. Cut at body of ventricle shows haematoma with blood-fluid level
www.eurorad.org • CC by-nc-sa-4.0
Blood -Fluid
Level in a Spontaneous Intraparenchymal hematoma. Cut at basal ganglia shows haematoma with very minimal peri-hematomal edema
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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.

  • primary hemorrhages (no underlying lesion)
  • 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 :

    • 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

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