Link To And Excerpts From Intracerebral Hemorrhage From Radiopaedia

In this post I link to and excerpt from Intracerebral hemorrhage, by Assoc Prof Frank Gaillard, from Radiopaedia, accessed 3-15-2021.

Here are excerpts:

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.

  1. primary hemorrhages (no underlying lesion)
  2. 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 3:

  • 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


  • 1. Brust JC. Current diagnosis and treatment in neurology. McGraw-Hill Medical. (2006) ISBN:0071423664. Read it at Google Books – Find it at Amazon
  • 2. Sacco RL, Kasner SE, Broderick JP et-al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44 (7): 2064-89. doi:10.1161/STR.0b013e318296aeca – Pubmed citation
  • 3. Barras CD, Asadi H, Phal PM, Tress BM, Davis SM, Desmond PM. Audit of CT reporting standards in cases of intracerebral haemorrhage at a comprehensive stroke centre in Australia. Journal of medical imaging and radiation oncology. 60 (6): 720-727. doi:10.1111/1754-9485.12491 – Pubmed
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