Spontaneous Intracerebral Hemorrhage

• Sites
  • Basal ganglia > thalamus > white matter > pons > cerebellum
• Morphology
  • No large areas of necrosis (vs. infarcts)
  • May dissect into ventricles, subarachnoid space
  • Duret hemorrhage if herniation occurs

Ultimately resorbed leaving fluid filled cavity

Saccular “Berry” Aneurysms

• Less common than ICH
• Most common cause of spontaneous subarachnoid hemorrhage
• Affects 1% of population
  • Polycystic kidney disease, fibromuscular dysplasia, coarctation of aorta, arteriovenous malformation
• Congenital defect of arterial wall (media) at branch points (80%)
• Site
  • 80% at bifurcations of anterior circulation
  • 15-20% posterior circulation
  • 25% multiple
• Manifestations
  • Local mass effect
  • Rupture into subarachnoid space
  • Rupture into brain
  • Secondary infarcts due to arterial spasm
• Presentation
  • Younger females (< 50)
  • Abrupt onset of signs of raised intracranial pressure
  • Meningeal signs (bloody CSF)
• Complications
  • 50% die within days
  • Infarcts after 4-9 days
  • Herniation
  • Hydrocephalus (organization may cause obstruction)