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Spontaneous intracerebral hemorrhage: Pathogenesis, clinical features, and diagnosis


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 — Hypertensive vasculopathy is the most common etiology of spontaneous ICH. Cerebral amyloid angiopathy is the most common cause of nontraumatic lobar ICH in the elderly, while vascular malformations are the most common cause of ICH in children [4]. Additional causes of nontraumatic ICH include:

  • Hemorrhagic infarction (including venous sinus thrombosis).
  • Septic embolism, mycotic aneurysm.
  • Brain tumor.
  • Bleeding disorders, anticoagulants, thrombolytic therapy.
  • Central nervous system (CNS) infection (eg, herpes simplex encephalitis).
  • Moyamoya.
  • Vasculitis.
  • Drugs (cocaine, amphetamines) [5]. Phenylpropanolamine in appetite suppressants, and possibly cold remedies, may be an independent risk factor for intracranial hemorrhage (including intracerebral hemorrhage and subarachnoid hemorrhage) in women [6,7].

These disorders are discussed elsewhere in appropriate topic reviews. (See "Cerebral amyloid angiopathy" and "Vascular malformations of the central nervous system".)


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Literature review current through: Sep 2014. | This topic last updated: May 14, 2012.
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