Intracerebral Hemorrhage

  • Etiology: trauma, anticoagulation, aneurysm, vascular malformation, vasculitis
  • Imaging: blood within cerebral parenchyma, if etiology is uncertain perform MRI and MRA or CTA to look for vascular causes
  • Complications: herniation
  • Treatment: evacuation of clot
  • Imaging evolution of intracerebral hemorrhage evolution on MRI:
    — Note: this is most commonly used to date subdural hematomas
AgeStateT1WIT2WI
< 1 dayOxyHbIsoBrightHyperacute
1-3 daysDeOxyHbIsoDarkAcute
3-7 daysIntracellularMetHbBrightDarkEarly Subacute
1-3 weeksExtracellularMetHbBrightBrightLate Subacute
> 3 weeksHemosiderinDarkDarkChronic

Cases of Intracerebral Hemorrhage

US of subdural hematoma and intracerebral hemorrhage in patient on extracorporeal membrane oxygenation (ECMO)
Coronal 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.
CT of intraventricular hemorrhage, intracerebral hemorrhage, and cerebral atrophy in a patient on extracorporeal membrane oxygenation (ECMO)
Axial CT without contrast of the brain shows mixed-density fluid in the left lateral ventricle posteriorly and mixed-density fluid in the left parietal-occipital lobe. There is also diffuse prominence of the sulci and ventricular system.
US of intracerebral hemorrhage in a patient on extracorporeal membrane oxygenation (ECMO)
Coronal and sagittal US of the brain shows a large, round echogenic lesion in the left parietal lobe.
CT of intracerebral hemorrhage in a patient on extracorporeal membrane oxygenation (ECMO)
Sagittal, coronal and axial CT without contrast of the brain shows a large, round high density lesion in the right parietal lobe.