Nontraumatic Intracranial Hemorrhage

Spontaneous ICH is usually intraparenchymal or subarachnoid in location. Intraparenchymal hemorrhages, encompassing lobar or centrally located hematomas, have diverse underlying causes, with cerebral amyloid angiopathy, characterized by lobar hemorrhage, being the most common. Hypertension is the second most common cause with a predilection for the basal ganglia, pons, and cerebellum. Subarachnoid hemorrhage is linked to aneurysm rupture in 85% of cases. Other relatively common causes of spontaneous intracranial hemorrhage include hemorrhagic conversion of ischemic infarction, cerebral arteriovenous malformations, dural arteriovenous fistulas, venous sinus thrombosis, cavernous malformations, reversible cerebral vasoconstriction syndrome, coagulopathy, and underlying tumors. Computed tomography followed by CT angiography is used for initial assessment of spontaneous ICH. However, MRI is more sensitive than CT for the detection of ICH and plays an important role in their etiology characterization. In this paper, the authors present a logical approach to imaging spontaneous intracranial hemorrhage including identifying prognostic factors, determining etiology, and establishing treatment.