Background: The many causes of Intracerebral Haemorrhage (IH) can be difficult to
differentiate. However, there are imaging features that can provide useful clues. This paper aims to
provide a pictorial review of the common causes of IH, to identify some distinguishing diagnostic
features and to provide guidance on subsequent imaging and follow up. It is hoped that this review
would benefit radiology and non-radiology consultants, multi-professional workers and trainees
who are commonly exposed to unenhanced CT head studies but are not neuroradiology specialists.
Discussion: In the absence of trauma, Spontaneous Intracerebral Haemorrhage (SIH) can be classified
as primary (80-85%) or secondary (15-20%). Primary includes those associated with hypertension
and amyloid angiopathy. The secondary is associated with underlying pathologies such as vascular
anomalies (Arteriovenous Malformations (AVMs), aneurysms and cavernomas), vasculitis,
malignancy and venous sinus thrombosis. SIH causes between 10 to 15% of all strokes and has a
higher mortality than ischaemic stroke. Trauma is another cause of IH with significant mortality
and some of the radiological features will be reviewed.
Conclusion: Unenhanced CT is a mainstay of acute phase imaging due to its availability and, sensitivity
and specificity for detecting acute haemorrhage. Several imaging features can be identified
on CT and, along with clinical information, can provide some certainty in diagnosis. For those suitable
and where diagnostic uncertainty remains CT angiogram, time-resolved CT angiography and
catheter angiography can help identify underlying AVMs, aneurysms, cavernomas and vasculitides.
MRI is more sensitive for the detection of subacute and chronic haemorrhage and identification
of underlying mass lesions.
Keywords: Intracerebral haemorrhage, amyloid angiopathy, hypertensive haemorrhage, vasculitis, venous sinus thrombosis, herpes encephalitis, vascular malformations
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