Intracerebral hemorrhage

From Radipedia
Jump to: navigation, search

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) [1].

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


  1. Rordorf G, McDonald C. Hypertensive intracerebral hemorrhage., 2007