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Spontaneous intracerebral hemorrhage: Pathogenesis, clinical features, and diagnosis

Guy Rordorf, MD
Colin McDonald, MD
Section Editor
Scott E Kasner, MD
Deputy Editor
Janet L Wilterdink, MD


Intracerebral hemorrhage (ICH) is the second most common cause of stroke, trailing only ischemic stroke in frequency [1,2]. Estimates of the annual incidence range from 16 to 33 cases per 100,000 [3]. There are many underlying pathological conditions associated with ICH; hypertension, amyloid angiopathy, ruptured saccular aneurysm, and vascular malformation account for the majority of cases.

The pathogenesis, epidemiology, clinical features, and diagnosis of ICH will be reviewed here, with an emphasis upon hypertensive hemorrhage. The prognosis and treatment of ICH are discussed separately. (See "Spontaneous intracerebral hemorrhage: Treatment and prognosis".)


Etiologies — Causes of nontraumatic ICH include [4-6]:


Cerebral amyloid angiopathy


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Literature review current through: Dec 2014. | This topic last updated: Dec 4, 2013.
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  1. Mohr JP, Caplan LR, Melski JW, et al. The Harvard Cooperative Stroke Registry: a prospective registry. Neurology 1978; 28:754.
  2. Broderick JP, Brott T, Tomsick T, et al. Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 1993; 78:188.
  3. Sacco S, Marini C, Toni D, et al. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke 2009; 40:394.
  4. Meretoja A, Strbian D, Putaala J, et al. SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage. Stroke 2012; 43:2592.
  5. Delgado Almandoz JE, Schaefer PW, Goldstein JN, et al. Practical scoring system for the identification of patients with intracerebral hemorrhage at highest risk of harboring an underlying vascular etiology: the Secondary Intracerebral Hemorrhage Score. AJNR Am J Neuroradiol 2010; 31:1653.
  6. van Asch CJ, Velthuis BK, Greving JP, et al. External validation of the secondary intracerebral hemorrhage score in The Netherlands. Stroke 2013; 44:2904.
  7. Martin-Schild S, Albright KC, Hallevi H, et al. Intracerebral hemorrhage in cocaine users. Stroke 2010; 41:680.
  8. Kernan WN, Viscoli CM, Brass LM, et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 2000; 343:1826.
  9. Yoon BW, Bae HJ, Hong KS, et al. Phenylpropanolamine contained in cold remedies and risk of hemorrhagic stroke. Neurology 2007; 68:146.
  10. Lee SM, Choi NK, Lee BC, et al. Caffeine-containing medicines increase the risk of hemorrhagic stroke. Stroke 2013; 44:2139.
  11. Beslow LA, Licht DJ, Smith SE, et al. Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study. Stroke 2010; 41:313.
  12. Garcia JH, Ho KL. Pathology of hypertensive arteriopathy. Neurosurg Clin N Am 1992; 3:497.
  13. Folsom AR, Yatsuya H, Mosley TH Jr, et al. Risk of intraparenchymal hemorrhage with magnetic resonance imaging-defined leukoaraiosis and brain infarcts. Ann Neurol 2012; 71:552.
  14. Offenbacher H, Fazekas F, Schmidt R, et al. MR of cerebral abnormalities concomitant with primary intracerebral hematomas. AJNR Am J Neuroradiol 1996; 17:573.
  15. Cheng AL, Batool S, McCreary CR, et al. Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds. Stroke 2013; 44:2782.
  16. Fazekas F, Kleinert R, Roob G, et al. Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. AJNR Am J Neuroradiol 1999; 20:637.
  17. Klein I, Iung B, Labreuche J, et al. Cerebral microbleeds are frequent in infective endocarditis: a case-control study. Stroke 2009; 40:3461.
  18. Lovelock CE, Cordonnier C, Naka H, et al. Antithrombotic drug use, cerebral microbleeds, and intracerebral hemorrhage: a systematic review of published and unpublished studies. Stroke 2010; 41:1222.
  19. Goos JD, Henneman WJ, Sluimer JD, et al. Incidence of cerebral microbleeds: a longitudinal study in a memory clinic population. Neurology 2010; 74:1954.
  20. Jeerakathil T, Wolf PA, Beiser A, et al. Cerebral microbleeds: prevalence and associations with cardiovascular risk factors in the Framingham Study. Stroke 2004; 35:1831.
  21. Sveinbjornsdottir S, Sigurdsson S, Aspelund T, et al. Cerebral microbleeds in the population based AGES-Reykjavik study: prevalence and location. J Neurol Neurosurg Psychiatry 2008; 79:1002.
  22. Walker DA, Broderick DF, Kotsenas AL, Rubino FA. Routine use of gradient-echo MRI to screen for cerebral amyloid angiopathy in elderly patients. AJR Am J Roentgenol 2004; 182:1547.
  23. Vernooij MW, van der Lugt A, Ikram MA, et al. Prevalence and risk factors of cerebral microbleeds: the Rotterdam Scan Study. Neurology 2008; 70:1208.
  24. Cordonnier C, Al-Shahi Salman R, Wardlaw J. Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting. Brain 2007; 130:1988.
  25. Fisher M, French S, Ji P, Kim RC. Cerebral microbleeds in the elderly: a pathological analysis. Stroke 2010; 41:2782.
  26. Altmann-Schneider I, Trompet S, de Craen AJ, et al. Cerebral microbleeds are predictive of mortality in the elderly. Stroke 2011; 42:638.
  27. Liu W, Liu R, Sun W, et al. Different impacts of blood pressure variability on the progression of cerebral microbleeds and white matter lesions. Stroke 2012; 43:2916.
  28. Staals J, van Oostenbrugge RJ, Knottnerus IL, et al. Brain microbleeds relate to higher ambulatory blood pressure levels in first-ever lacunar stroke patients. Stroke 2009; 40:3264.
  29. Poels MM, Ikram MA, van der Lugt A, et al. Incidence of cerebral microbleeds in the general population: the Rotterdam Scan Study. Stroke 2011; 42:656.
  30. Klarenbeek P, van Oostenbrugge RJ, Rouhl RP, et al. Higher ambulatory blood pressure relates to new cerebral microbleeds: 2-year follow-up study in lacunar stroke patients. Stroke 2013; 44:978.
  31. Roob G, Schmidt R, Kapeller P, et al. MRI evidence of past cerebral microbleeds in a healthy elderly population. Neurology 1999; 52:991.
  32. Tsushima Y, Tanizaki Y, Aoki J, Endo K. MR detection of microhemorrhages in neurologically healthy adults. Neuroradiology 2002; 44:31.
  33. Bokura H, Saika R, Yamaguchi T, et al. Microbleeds are associated with subsequent hemorrhagic and ischemic stroke in healthy elderly individuals. Stroke 2011; 42:1867.
  34. Charidimou A, Kakar P, Fox Z, Werring DJ. Cerebral microbleeds and recurrent stroke risk: systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts. Stroke 2013; 44:995.
  35. Lahousse L, Vernooij MW, Darweesh SK, et al. Chronic obstructive pulmonary disease and cerebral microbleeds. The Rotterdam Study. Am J Respir Crit Care Med 2013; 188:783.
  36. Xu BN, Yabuki A, Mishina H, et al. Pathophysiology of brain swelling after acute experimental brain compression and decompression. Neurosurgery 1993; 32:289.
  37. Zazulia AR, Videen TO, Powers WJ. Transient focal increase in perihematomal glucose metabolism after acute human intracerebral hemorrhage. Stroke 2009; 40:1638.
  38. Murai Y, Ikeda Y, Teramoto A, Tsuji Y. Magnetic resonance imaging-documented extravasation as an indicator of acute hypertensive intracerebral hemorrhage. J Neurosurg 1998; 88:650.
  39. Aksoy D, Bammer R, Mlynash M, et al. Magnetic resonance imaging profile of blood-brain barrier injury in patients with acute intracerebral hemorrhage. J Am Heart Assoc 2013; 2:e000161.
  40. Kidwell CS, Burgess R, Menon R, et al. Hyperacute injury marker (HARM) in primary hemorrhage: a distinct form of CNS barrier disruption. Neurology 2011; 77:1725.
  41. Venkatasubramanian C, Mlynash M, Finley-Caulfield A, et al. Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging. Stroke 2011; 42:73.
  42. Staykov D, Wagner I, Volbers B, et al. Natural course of perihemorrhagic edema after intracerebral hemorrhage. Stroke 2011; 42:2625.
  43. Li N, Worthmann H, Heeren M, et al. Temporal pattern of cytotoxic edema in the perihematomal region after intracerebral hemorrhage: a serial magnetic resonance imaging study. Stroke 2013; 44:1144.
  44. Olivot JM, Mlynash M, Kleinman JT, et al. MRI profile of the perihematomal region in acute intracerebral hemorrhage. Stroke 2010; 41:2681.
  45. Balami JS, Buchan AM. Complications of intracerebral haemorrhage. Lancet Neurol 2012; 11:101.
  46. Dearden NM. Mechanisms and prevention of secondary brain damage during intensive care. Clin Neuropathol 1998; 17:221.
  47. Mendelow AD. Mechanisms of ischemic brain damage with intracerebral hemorrhage. Stroke 1993; 24:I115.
  48. Oeinck M, Neunhoeffer F, Buttler KJ, et al. Dynamic cerebral autoregulation in acute intracerebral hemorrhage. Stroke 2013; 44:2722.
  49. Lee KR, Kawai N, Kim S, et al. Mechanisms of edema formation after intracerebral hemorrhage: effects of thrombin on cerebral blood flow, blood-brain barrier permeability, and cell survival in a rat model. J Neurosurg 1997; 86:272.
  50. Rosenberg GA, Navratil M. Metalloproteinase inhibition blocks edema in intracerebral hemorrhage in the rat. Neurology 1997; 48:921.
  51. Xi G, Wagner KR, Keep RF, et al. Role of blood clot formation on early edema development after experimental intracerebral hemorrhage. Stroke 1998; 29:2580.
  52. Makogonenko E, Tsurupa G, Ingham K, Medved L. Interaction of fibrin(ogen) with fibronectin: further characterization and localization of the fibronectin-binding site. Biochemistry 2002; 41:7907.
  53. Castillo J, Dávalos A, Alvarez-Sabín J, et al. Molecular signatures of brain injury after intracerebral hemorrhage. Neurology 2002; 58:624.
  54. Abilleira S, Montaner J, Molina CA, et al. Matrix metalloproteinase-9 concentration after spontaneous intracerebral hemorrhage. J Neurosurg 2003; 99:65.
  55. Menon RS, Burgess RE, Wing JJ, et al. Predictors of highly prevalent brain ischemia in intracerebral hemorrhage. Ann Neurol 2012; 71:199.
  56. Garg RK, Liebling SM, Maas MB, et al. Blood pressure reduction, decreased diffusion on MRI, and outcomes after intracerebral hemorrhage. Stroke 2012; 43:67.
  57. Kang DW, Han MK, Kim HJ, et al. New ischemic lesions coexisting with acute intracerebral hemorrhage. Neurology 2012; 79:848.
  58. Auriel E, Gurol ME, Ayres A, et al. Characteristic distributions of intracerebral hemorrhage-associated diffusion-weighted lesions. Neurology 2012; 79:2335.
  59. Prabhakaran S, Naidech AM. Ischemic brain injury after intracerebral hemorrhage: a critical review. Stroke 2012; 43:2258.
  60. Broderick JP, Brott TG, Tomsick T, et al. Ultra-early evaluation of intracerebral hemorrhage. J Neurosurg 1990; 72:195.
  61. Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997; 28:1.
  62. Silva Y, Leira R, Tejada J, et al. Molecular signatures of vascular injury are associated with early growth of intracerebral hemorrhage. Stroke 2005; 36:86.
  63. Barras CD, Tress BM, Christensen S, et al. Density and shape as CT predictors of intracerebral hemorrhage growth. Stroke 2009; 40:1325.
  64. Chen ST, Chen SD, Hsu CY, Hogan EL. Progression of hypertensive intracerebral hemorrhage. Neurology 1989; 39:1509.
  65. Qureshi AI, Wilson DA, Hanley DF, Traystman RJ. Pharmacologic reduction of mean arterial pressure does not adversely affect regional cerebral blood flow and intracranial pressure in experimental intracerebral hemorrhage. Crit Care Med 1999; 27:965.
  66. Kazui S, Minematsu K, Yamamoto H, et al. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke 1997; 28:2370.
  67. Fujii Y, Takeuchi S, Sasaki O, et al. Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage. Stroke 1998; 29:1160.
  68. Jauch EC, Lindsell CJ, Adeoye O, et al. Lack of evidence for an association between hemodynamic variables and hematoma growth in spontaneous intracerebral hemorrhage. Stroke 2006; 37:2061.
  69. Broderick JP, Diringer MN, Hill MD, et al. Determinants of intracerebral hemorrhage growth: an exploratory analysis. Stroke 2007; 38:1072.
  70. Ohwaki K, Yano E, Nagashima H, et al. Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke 2004; 35:1364.
  71. Delgado Almandoz JE, Yoo AJ, Stone MJ, et al. Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion: the spot sign score. Stroke 2009; 40:2994.
  72. Goldstein JN, Fazen LE, Snider R, et al. Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage. Neurology 2007; 68:889.
  73. Wada R, Aviv RI, Fox AJ, et al. CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage. Stroke 2007; 38:1257.
  74. Delgado Almandoz JE, Yoo AJ, Stone MJ, et al. The spot sign score in primary intracerebral hemorrhage identifies patients at highest risk of in-hospital mortality and poor outcome among survivors. Stroke 2010; 41:54.
  75. Rodriguez-Luna D, Rubiera M, Ribo M, et al. Ultraearly hematoma growth predicts poor outcome after acute intracerebral hemorrhage. Neurology 2011; 77:1599.
  76. Li N, Wang Y, Wang W, et al. Contrast extravasation on computed tomography angiography predicts clinical outcome in primary intracerebral hemorrhage: a prospective study of 139 cases. Stroke 2011; 42:3441.
  77. Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, et al. Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. Lancet Neurol 2012; 11:307.
  78. Brouwers HB, Goldstein JN, Romero JM, Rosand J. Clinical applications of the computed tomography angiography spot sign in acute intracerebral hemorrhage: a review. Stroke 2012; 43:3427.
  79. Romero JM, Brouwers HB, Lu J, et al. Prospective validation of the computed tomographic angiography spot sign score for intracerebral hemorrhage. Stroke 2013; 44:3097.
  80. Huynh TJ, Demchuk AM, Dowlatshahi D, et al. Spot sign number is the most important spot sign characteristic for predicting hematoma expansion using first-pass computed tomography angiography: analysis from the PREDICT study. Stroke 2013; 44:972.
  81. Ederies A, Demchuk A, Chia T, et al. Postcontrast CT extravasation is associated with hematoma expansion in CTA spot negative patients. Stroke 2009; 40:1672.
  82. Brouwers HB, Biffi A, McNamara KA, et al. Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage. Stroke 2012; 43:2120.
  83. Evans A, Demchuk A, Symons SP, et al. The spot sign is more common in the absence of multiple prior microbleeds. Stroke 2010; 41:2210.
  84. Brouwers HB, Biffi A, Ayres AM, et al. Apolipoprotein E genotype predicts hematoma expansion in lobar intracerebral hemorrhage. Stroke 2012; 43:1490.
  85. Hanley DF. Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage. Stroke 2009; 40:1533.
  86. Nyquist P, Hanley DF. The use of intraventricular thrombolytics in intraventricular hemorrhage. J Neurol Sci 2007; 261:84.
  87. Maas MB, Nemeth AJ, Rosenberg NF, et al. Delayed intraventricular hemorrhage is common and worsens outcomes in intracerebral hemorrhage. Neurology 2013; 80:1295.
  88. Kannel WB, Wolf PA, Verter J, McNamara PM. Epidemiologic assessment of the role of blood pressure in stroke: the Framingham Study. 1970. JAMA 1996; 276:1269.
  89. Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 2007; 38:2001.
  90. Kimura Y, Takishita S, Muratani H, et al. Demographic study of first-ever stroke and acute myocardial infarction in Okinawa, Japan. Intern Med 1998; 37:736.
  91. Gebel JM, Broderick JP. Intracerebral hemorrhage. Neurol Clin 2000; 18:419.
  92. Flaherty ML, Woo D, Haverbusch M, et al. Racial variations in location and risk of intracerebral hemorrhage. Stroke 2005; 36:934.
  93. Labovitz DL, Halim A, Boden-Albala B, et al. The incidence of deep and lobar intracerebral hemorrhage in whites, blacks, and Hispanics. Neurology 2005; 65:518.
  94. van Asch CJ, Luitse MJ, Rinkel GJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010; 9:167.
  95. Stein M, Misselwitz B, Hamann GF, et al. Intracerebral hemorrhage in the very old: future demographic trends of an aging population. Stroke 2012; 43:1126.
  96. Bruno A, Carter S, Qualls C, Nolte KB. Incidence of spontaneous intracerebral hemorrhage among Hispanics and non-Hispanic whites in New Mexico. Neurology 1996; 47:405.
  97. Morgenstern LB, Smith MA, Lisabeth LD, et al. Excess stroke in Mexican Americans compared with non-Hispanic Whites: the Brain Attack Surveillance in Corpus Christi Project. Am J Epidemiol 2004; 160:376.
  98. Lovelock CE, Molyneux AJ, Rothwell PM, Oxford Vascular Study. Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study. Lancet Neurol 2007; 6:487.
  99. Woo D, Sauerbeck LR, Kissela BM, et al. Genetic and environmental risk factors for intracerebral hemorrhage: preliminary results of a population-based study. Stroke 2002; 33:1190.
  100. Woo D, Haverbusch M, Sekar P, et al. Effect of untreated hypertension on hemorrhagic stroke. Stroke 2004; 35:1703.
  101. Feldmann E, Broderick JP, Kernan WN, et al. Major risk factors for intracerebral hemorrhage in the young are modifiable. Stroke 2005; 36:1881.
  102. Zia E, Hedblad B, Pessah-Rasmussen H, et al. Blood pressure in relation to the incidence of cerebral infarction and intracerebral hemorrhage. Hypertensive hemorrhage: debated nomenclature is still relevant. Stroke 2007; 38:2681.
  103. Thrift AG, McNeil JJ, Forbes A, Donnan GA. Three important subgroups of hypertensive persons at greater risk of intracerebral hemorrhage. Melbourne Risk Factor Study Group. Hypertension 1998; 31:1223.
  104. Martini SR, Flaherty ML, Brown WM, et al. Risk factors for intracerebral hemorrhage differ according to hemorrhage location. Neurology 2012; 79:2275.
  105. Jackson CA, Sudlow CL. Is hypertension a more frequent risk factor for deep than for lobar supratentorial intracerebral haemorrhage? J Neurol Neurosurg Psychiatry 2006; 77:1244.
  106. Ritter MA, Droste DW, Hegedüs K, et al. Role of cerebral amyloid angiopathy in intracerebral hemorrhage in hypertensive patients. Neurology 2005; 64:1233.
  107. Arima H, Tzourio C, Anderson C, et al. Effects of perindopril-based lowering of blood pressure on intracerebral hemorrhage related to amyloid angiopathy: the PROGRESS trial. Stroke 2010; 41:394.
  108. Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 2003; 34:2060.
  109. Sturgeon JD, Folsom AR, Longstreth WT Jr, et al. Risk factors for intracerebral hemorrhage in a pooled prospective study. Stroke 2007; 38:2718.
  110. Howard G, Cushman M, Howard VJ, et al. Risk factors for intracerebral hemorrhage: the REasons for geographic and racial differences in stroke (REGARDS) study. Stroke 2013; 44:1282.
  111. Thrift AG, McNeil JJ, Forbes A, Donnan GA. Risk factors for cerebral hemorrhage in the era of well-controlled hypertension. Melbourne Risk Factor Study (MERFS) Group. Stroke 1996; 27:2020.
  112. Giroud M, Creisson E, Fayolle H, et al. Risk factors for primary cerebral hemorrhage: a population-based study--the Stroke Registry of Dijon. Neuroepidemiology 1995; 14:20.
  113. Iribarren C, Jacobs DR, Sadler M, et al. Low total serum cholesterol and intracerebral hemorrhagic stroke: is the association confined to elderly men? The Kaiser Permanente Medical Care Program. Stroke 1996; 27:1993.
  114. González-Duarte A, Cantú C, Ruíz-Sandoval JL, Barinagarrementeria F. Recurrent primary cerebral hemorrhage: frequency, mechanisms, and prognosis. Stroke 1998; 29:1802.
  115. Segal AZ, Chiu RI, Eggleston-Sexton PM, et al. Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case-control study. Neuroepidemiology 1999; 18:185.
  116. Yano K, Reed DM, MacLean CJ. Serum cholesterol and hemorrhagic stroke in the Honolulu Heart Program. Stroke 1989; 20:1460.
  117. Shinkawa A, Ueda K, Hasuo Y, et al. Seasonal variation in stroke incidence in Hisayama, Japan. Stroke 1990; 21:1262.
  118. Noda H, Iso H, Irie F, et al. Low-density lipoprotein cholesterol concentrations and death due to intraparenchymal hemorrhage: the Ibaraki Prefectural Health Study. Circulation 2009; 119:2136.
  119. Wang X, Dong Y, Qi X, et al. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke 2013; 44:1833.
  120. Woo D, Deka R, Falcone GJ, et al. Apolipoprotein E, statins, and risk of intracerebral hemorrhage. Stroke 2013; 44:3013.
  121. Mustanoja S, Strbian D, Putaala J, et al. Association of prestroke statin use and lipid levels with outcome of intracerebral hemorrhage. Stroke 2013; 44:2330.
  122. Woo D, Kissela BM, Khoury JC, et al. Hypercholesterolemia, HMG-CoA reductase inhibitors, and risk of intracerebral hemorrhage: a case-control study. Stroke 2004; 35:1360.
  123. Amarenco P, Labreuche J, Lavallée P, Touboul PJ. Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis. Stroke 2004; 35:2902.
  124. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366:1267.
  125. Leker RR, Khoury ST, Rafaeli G, et al. Prior use of statins improves outcome in patients with intracerebral hemorrhage: prospective data from the National Acute Stroke Israeli Surveys (NASIS). Stroke 2009; 40:2581.
  126. Hackam DG, Austin PC, Huang A, et al. Statins and intracerebral hemorrhage: a retrospective cohort study. Arch Neurol 2012; 69:39.
  127. Hackam DG, Woodward M, Newby LK, et al. Statins and intracerebral hemorrhage: collaborative systematic review and meta-analysis. Circulation 2011; 124:2233.
  128. McKinney JS, Kostis WJ. Statin therapy and the risk of intracerebral hemorrhage: a meta-analysis of 31 randomized controlled trials. Stroke 2012; 43:2149.
  129. Dowlatshahi D, Demchuk AM, Fang J, et al. Association of statins and statin discontinuation with poor outcome and survival after intracerebral hemorrhage. Stroke 2012; 43:1518.
  130. Bos MJ, Koudstaal PJ, Hofman A, Breteler MM. Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke: the Rotterdam Study. Stroke 2007; 38:3127.
  131. Ovbiagele B, Wing JJ, Menon RS, et al. Association of chronic kidney disease with cerebral microbleeds in patients with primary intracerebral hemorrhage. Stroke 2013; 44:2409.
  132. Shimizu Y, Maeda K, Imano H, et al. Chronic kidney disease and drinking status in relation to risks of stroke and its subtypes: the Circulatory Risk in Communities Study (CIRCS). Stroke 2011; 42:2531.
  133. Hackam DG, Mrkobrada M. Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis. Neurology 2012; 79:1862.
  134. Biffi A, Sonni A, Anderson CD, et al. Variants at APOE influence risk of deep and lobar intracerebral hemorrhage. Ann Neurol 2010; 68:934.
  135. Weng YC, Sonni A, Labelle-Dumais C, et al. COL4A1 mutations in patients with sporadic late-onset intracerebral hemorrhage. Ann Neurol 2012; 71:470.
  136. Anderson CD, Biffi A, Nalls MA, et al. Common variants within oxidative phosphorylation genes influence risk of ischemic stroke and intracerebral hemorrhage. Stroke 2013; 44:612.
  137. Biffi A, Anderson CD, Falcone GJ, et al. Novel insights into the genetics of intracerebral hemorrhage. Stroke 2013; 44:S137.
  138. Devan WJ, Falcone GJ, Anderson CD, et al. Heritability estimates identify a substantial genetic contribution to risk and outcome of intracerebral hemorrhage. Stroke 2013; 44:1578.
  139. Falcone GJ, Biffi A, Devan WJ, et al. Burden of risk alleles for hypertension increases risk of intracerebral hemorrhage. Stroke 2012; 43:2877.
  140. Sacco S, Ornello R, Ripa P, et al. Migraine and hemorrhagic stroke: a meta-analysis. Stroke 2013; 44:3032.
  141. Flaherty ML, Tao H, Haverbusch M, et al. Warfarin use leads to larger intracerebral hematomas. Neurology 2008; 71:1084.
  142. He J, Whelton PK, Vu B, Klag MJ. Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. JAMA 1998; 280:1930.
  143. Hart RG, Halperin JL, McBride R, et al. Aspirin for the primary prevention of stroke and other major vascular events: meta-analysis and hypotheses. Arch Neurol 2000; 57:326.
  144. García-Rodríguez LA, Gaist D, Morton J, et al. Antithrombotic drugs and risk of hemorrhagic stroke in the general population. Neurology 2013; 81:566.
  145. Gorelick PB, Weisman SM. Risk of hemorrhagic stroke with aspirin use: an update. Stroke 2005; 36:1801.
  146. ACTIVE Investigators, Connolly SJ, Pogue J, et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009; 360:2066.
  147. Thrift AG, McNeil JJ, Forbes A, Donnan GA. Risk of primary intracerebral haemorrhage associated with aspirin and non-steroidal anti-inflammatory drugs: case-control study. BMJ 1999; 318:759.
  148. Bak S, Andersen M, Tsiropoulos I, et al. Risk of stroke associated with nonsteroidal anti-inflammatory drugs: a nested case-control study. Stroke 2003; 34:379.
  149. Johnsen SP, Pedersen L, Friis S, et al. Nonaspirin nonsteroidal anti-inflammatory drugs and risk of hospitalization for intracerebral hemorrhage: a population-based case-control study. Stroke 2003; 34:387.
  150. Choi NK, Park BJ, Jeong SW, et al. Nonaspirin nonsteroidal anti-inflammatory drugs and hemorrhagic stroke risk: the Acute Brain Bleeding Analysis study. Stroke 2008; 39:845.
  151. Toyoda K, Yasaka M, Uchiyama S, et al. Blood pressure levels and bleeding events during antithrombotic therapy: the Bleeding with Antithrombotic Therapy (BAT) Study. Stroke 2010; 41:1440.
  152. Faught E, Peters D, Bartolucci A, et al. Seizures after primary intracerebral hemorrhage. Neurology 1989; 39:1089.
  153. Passero S, Rocchi R, Rossi S, et al. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia 2002; 43:1175.
  154. Vespa PM, O'Phelan K, Shah M, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology 2003; 60:1441.
  155. Claassen J, Jetté N, Chum F, et al. Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology 2007; 69:1356.
  156. Davis AM, Natelson BH. Brain-heart interactions. The neurocardiology of arrhythmia and sudden cardiac death. Tex Heart Inst J 1993; 20:158.
  157. Stroke pathophysiology, diagnosis, and management, Barnett HJ, Mohr JP, Stein BM (Eds), Churchill Livingstone, Philadelphia 1998.
  158. Kidwell CS, Wintermark M. Imaging of intracranial haemorrhage. Lancet Neurol 2008; 7:256.
  159. Lovelock CE, Anslow P, Molyneux AJ, et al. Substantial observer variability in the differentiation between primary intracerebral hemorrhage and hemorrhagic transformation of infarction on CT brain imaging. Stroke 2009; 40:3763.
  160. Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke 1996; 27:1304.
  161. Beslow LA, Ichord RN, Kasner SE, et al. ABC/XYZ estimates intracerebral hemorrhage volume as a percent of total brain volume in children. Stroke 2010; 41:691.
  162. Morgenstern LB, Hemphill JC 3rd, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010; 41:2108.
  163. Edelman RR, Johnson K, Buxton R, et al. MR of hemorrhage: a new approach. AJNR Am J Neuroradiol 1986; 7:751.
  164. Patel MR, Edelman RR, Warach S. Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. Stroke 1996; 27:2321.
  165. Schellinger PD, Jansen O, Fiebach JB, et al. A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage. Stroke 1999; 30:765.
  166. Linfante I, Llinas RH, Caplan LR, Warach S. MRI features of intracerebral hemorrhage within 2 hours from symptom onset. Stroke 1999; 30:2263.
  167. Kidwell CS, Saver JL, Mattiello J, et al. Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage. Neurology 2001; 57:1611.
  168. Fiebach JB, Schellinger PD, Gass A, et al. Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke 2004; 35:502.
  169. Kidwell CS, Chalela JA, Saver JL, et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 2004; 292:1823.
  170. Charidimou A, Meegahage R, Fox Z, et al. Enlarged perivascular spaces as a marker of underlying arteriopathy in intracerebral haemorrhage: a multicentre MRI cohort study. J Neurol Neurosurg Psychiatry 2013; 84:624.
  171. Cordonnier C, Klijn CJ, van Beijnum J, Al-Shahi Salman R. Radiological investigation of spontaneous intracerebral hemorrhage: systematic review and trinational survey. Stroke 2010; 41:685.
  172. Kase CS, Robinson RK, Stein RW, et al. Anticoagulant-related intracerebral hemorrhage. Neurology 1985; 35:943.
  173. Kase CS. Bleeding disorders. In: Intracerebral Hemorrhage, Kase CS, Caplan LR (Eds), Butterworth-Heinemann, Boston 1994. p.117.
  174. Alberico RA, Patel M, Casey S, et al. Evaluation of the circle of Willis with three-dimensional CT angiography in patients with suspected intracranial aneurysms. AJNR Am J Neuroradiol 1995; 16:1571.
  175. Edelman RR, Mattle HP, Atkinson DJ, Hoogewoud HM. MR angiography. AJR Am J Roentgenol 1990; 154:937.
  176. Oleinik A, Romero JM, Schwab K, et al. CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy. Stroke 2009; 40:2393.
  177. Wong GK, Siu DY, Abrigo JM, et al. Computed tomographic angiography and venography for young or nonhypertensive patients with acute spontaneous intracerebral hemorrhage. Stroke 2011; 42:211.