Abstract
Two types of hemorrhagic stroke include intracerebral (intraparenchymal) hemorrhage (ICH) and subarachnoid hemorrhage (SAH). The acute ICH shows hyperdensity on CT and can easily be diagnosed. In the subacute stage, the density of hematoma gradually decreases, and the brain edema around the hematoma becomes obvious. In the chronic stage, a linear cavity in the original ICH location is observed and associated with peripheral brain tissue atrophy. MRI is an auxiliary tool for diagnosing ICH. The evolution of ICH is complicated in MRI, and it is divided into five stages. ICH is most often caused by hypertension, and the locations are in deep areas, such as the putamen, thalamus, brainstem, and cerebellum. Lobar hemorrhage is primarily caused by amyloid angiopathy, AVM, and tumor bleeding. For the diagnosis of ICH, plain CT is usually sufficient. In young stroke and lobar hemorrhage, contrast-enhanced CT plus CTA and even DSA can be performed to find a vascular anomaly or others. Most spontaneous SAH is caused by the rupture (leakage) of an aneurysm. Most aneurysms are located in the circle of Willis. CTA can detect most of the aneurysms. In addition to SAH, 30% of aneurysm rupture may combine ICH. The ICH provides a valuable clue to surmise the location of aneurysms, such as if an ICH is in the frontal lobe or septum pellucidum, the aneurysm is in the ACoA; an ICH in the mesial temporal lobe, the aneurysm is in the ICA/PCoA; and a hematoma in Sylvian fissure, the aneurysm is in the bifurcation of MCA.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ripoll MA, et al. Detection and appearance of intraparenchymal haematomas of the brain at 1.5T with spin-echo, FLAIR and GE sequences: poor relationship to the age of the haematomas. Neuroradiology. 2004;46:435–43.
Bradley WG. MR appearance of hemorrhage in the brain. Radiology. 1993;189:15–26.
Kidwell CS, et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 2004;292:1823–30.
Macdonald RL, Schweizer TA. Spontaneous subarachnoid hemorrhage. Lancet. 2017;389:655–66.
Agid R, et al. Negative CT angiography findings in patients with spontaneous subarachnoid hemorrhage: when is digital subtraction angiography still needed? AJNR Am J Neuroradiol. 2010;31:696–705.
Rinkel GJ, et al. Subarachnoid hemorrhage without detectable aneurysm: a review of the causes. Stroke. 1993;24:1403–9.
Larsen CC, Astrup J. Rebleeding after aneurysmal subarachnoid hemorrhage: a literature review. World Neurosurg. 2013;79:307–12.
Bracchi M, et al. Superficial siderosis of the CNS: MR diagnosis and clinical findings. AJNR Am J Neuroradiol. 1993;14:227–36.
Morita A, et al. The natural course of unruptured cerebral aneurysm in a Japanese cohort. N Engl J Med. 2012;366:2474–82.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2021 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Shen, WC. (2021). Medical Imaging of Cerebral Hemorrhagic Stroke. In: Diagnostic Neuroradiology. Springer, Singapore. https://doi.org/10.1007/978-981-15-4051-6_4
Download citation
DOI: https://doi.org/10.1007/978-981-15-4051-6_4
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-15-4050-9
Online ISBN: 978-981-15-4051-6
eBook Packages: MedicineMedicine (R0)