ICH Etiologies
Hypertensive Hemorrhage
- Suspect in those with bleeding in the basal ganglia, pons, midbrain, cerebellar nuclei and uncontrolled hypertension
Cerebral Amyloid Angiopathy
- Suspect in older age adults with lobar or cerebellar hemorrhage especially with MRI showing findings of chronic cerebral microbleeds or superficial siderosis on GRE
Vascular Malformations (AVMs & CM)
- Suspect in those with spontaneous bleeding in lobar, intraventricular, or subarachnoid regions for AVM and brainstem, juxtacortical regions, or intraventricular space for CM
- AVMs can be identified on CTA/MRA with high sensitivity but angiogram is confirmatory and necessary for treatment planning.
- CMs can be identified on MRI as a popcorn pattern which represents variable image intensities consistent with evolving blood products
Cerebral Venous Sinus Thrombosis
- Suspect in those where infarct/hemorrhage crosses multiple vascular territories or located along parasagittal structures (following sagittal sinus thrombosis), temporoparietal regions (transverse / sigmoid sinus thrombi), or deep structures.
Hemorrhagic Transformation of Ischemic Infarct
- Suspect in those where hemorrhage is within the stroke bed.
- MRI will show diffusion restriction in the pattern of an ischemic infarct
Primary or Secondary CNS Malignancy
- Suspect in those with a history of malignancy (metastases) or those with possible primary brain tumors especially when there is significant vasogenic edema around the hemorrhage site.
- Repeat imaging will be required once blood has reabsorbed to properly visualize underlying tumor
Cerebral Hyperperfusion Syndrome (post-revascularization)
- Suspect in those with headache after a recent carotid endarterectomy especially if there was high grade (>80%) stenosis or recent infarct
- Risk highest 1 week post surgery however has been reported up to 1 month later
Acquired or Genetic Bleeding Disorders
- Suspect in those on AP/AC, thrombolytics, liver disease, and other bleeding disorders after other causes are excluded