| Summary: | Spontaneous intracerebral hemorrhage is a frequent cause of sudden neurologic deficits. Since clinical stroke is caused in 10-15% by intracerebral bleeding, these patients represent a major part of neuroradiologic emergency procedures. Hypertensive intracerebral bleeding is most frequent, a condition that, apart from occasional surgical evacuation for the relief of intracranial pressure, does not warrant specific treatment. Many other underlying forms of pathology, however, need specific attention and have to be rapidly and efficiently diagnosed. A rational diagnostic strategy should account for the localization of the hematoma as well as for the patient's age and risk profile. Hypertensive bleedings are located in the deep cerebral compartments and occur in elderly and hypertensive persons. Initial imaging is most frequently performed in the acute stage for possible thrombolysis of clinical stroke. In typical cases, no further imaging including contrast administration, CT angiography (CTA), digital subtraction angiography (DSA) or magnetic resonance imaging (MRI) are necessary. A superficial localization of the hemorrhage, subarachnoid extension, young age or an atypical clinical presentation requires further imaging work-up. To rule out vascular malformations, venous thrombosis and cerebral aneurysms, CTA is applied in the acute phase. Further imaging including DSA and MRI is performed during the next days before hemoglobin degradation renders MRI detection of contrast-enhancing lesions difficult. Some forms of pathology like cavernous hemangiomas may require the complete resorption of the hemorrhage for secure diagnosis, which usually occurs not earlier than after 3-6 months. © Urban and Vogel.
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