Intracerebral hemorrhage

ICH

Intracerebral hemorrhage (ICH) is the third most common cause of stroke, after embolic and atherosclerotic thrombosis.

Common underlying diseases include hypertension, amyloid angiopathy, ruptured saccular aneurysm, and vascular malformation. Other causes include trauma, hemorrhagic infarction, septic embolism, brain tumor, bleeding disorders, anticoagulants, thrombolytic therapy, CNS infection, Mycotic aneurysm, Moyamoya, vasculitis, and drugs (cocaine, amphetamines, phenylpropanolamine) .

Intracerebral Hemorrhage on MRI

Phase	Time	Hemoglobin	T1	T2
Hyperacute	< 24 hrs	Oxyhemoglobin (intracellular)	Iso or hypo	Hyper
Acute	1-3 days	Deoxyhemoglobin (intracellular)	Iso or hypo	Hypo
Early Subacute	>3 days	Methemoglobin (intracellular)	Hyper	Hypo
Late Subacute	>7 days	Methemoglobin (extracellular)	Hyper	Hyper
Chronic	>14 days	Hemosiderin (extracellular)	Iso or hypo	Hypo

Mnemonic based on T1 and T2 changes:

I Bleed, I Die, Bleed Die, Bleed Bleed, Die Die. (I-iso, B-hyper, D-Hypo)

I Bleed (hyperacute), I Die (acute), Bleed Die (early subacute), Bleed Bleed (late subacute), Die Die (chronic)

Hgb Products over time: Oh Death MIss ME Here

Oxy, Deoxy, Methhem- (Intracellular), Methhem- (Extrecellular), Hemosiderin

Acute:T1 Iso

Acute:T2 Dark

Acute CT

Duret hemorrhage - bleeding with the brainstem (midbrain and pons) as a result of increased intracranial pressure and displacement