Specifying ICH feature | Characteristic underlying cause | Other associated features | Alternative underlying causes |
Basal ganglia or brainstem location | Deep perforating vasculopathy (HTN) | - CMBs in basal ganglia, thalamus, pons, cerebellar nuclei
- Subcortical white matter lesions on MRI
- Deep perforating territory ischemic infarcts
- Clinical history of HTN or diabetes mellitus
| |
Lobar location | Cerebral amyloid angiopathy | - Cortico-subcortical CMBs
- Convexal superficial siderosis
- Clinical history of cognitive impairment
| Deep penetrating vasculopathy (HTN) |
Intraventricular hemorrhage | Arteriovenous malformation | - Flow voids within or adjacent to ICH
- Calcification within or adjacent to ICH
| Deep penetrating vasculopathy (HTN) Cavernous malformation |
Small ICH with adjacent calcification | Cavernous malformation | - T2-weighted image hyperintensity at center on MRI
- Peripheral rim of T2*-weighted gradient echo image hypointensity on MRI
| Deep penetrating vasculopathy (HTN) |
Subarachnoid hemorrhage – Basal cisterns | Ruptured cerebral aneurysm | - SAH predominates over basal surfaces
- Clinical history of thunderclap headache
| Perimesencephalic hemorrhage Non-aneurysmal SAH |
Subarachnoid hemorrhage – Convexity | Reversible cerebral vasoconstriction syndrome | - Hemispheric or cortical ICH
- Clinical history of recurrent thunderclap headache
| Trauma Cerebral amyloid angiopathy Cerebral venous thrombosis Arteriovenous malformation |
Simultaneous acute infarcts | Infective endocarditis | - CMBs
- Mycotic aneurysms (typically distal arterial locations)
- Systemic/cutaneous evidence of embolism
- New heart murmur
| Cerebral amyloid angiopathy Deep penetrating vasculopathy (HTN) |
Cerebral vasculitis | - Multifocal segmental narrowing on vascular imaging
- Clinical history of new persistent headaches
- Progressive cognitive or other neurologic impairment
|
Prominent edema | Cerebral sinus thrombosis | - Edema/hemorrhage extends to cortical surface
- Venous flow void (eg, delta and empty-delta signs)
- Clinical history of seizure or progressive headache
| Subacute ICH of other etiologies |
Tumor (primary/metastatic) | - Multifocal lesions
- Contrast enhancement
- Clinical history of new persistent headaches
- Clinical exam findings may be milder than imaging abnormalities
|
Hemorrhagic transformation of infarct | - (Cytotoxic) Edema appears in distribution of arterial territory
- Arterial stenosis or occlusion proximal to territory of hemorrhage
- Clinical history of ischemic risk factors
|
Flow voids | Moyamoya | - Basal ganglia or hemispheric location
- Bilateral (but may be asymmetric) narrowing of distal internal carotid or proximal anterior/middle cerebral arteries
- Clinical history of episodes of transient weakness with vigorous laughing/crying
- (Prominent cause of ICH and infarcts in children)
| Arteriovenous malformation |