Spontaneous intracerebral hemorrhage occurs when a blood vessel within the brain parenchyma ruptures without a near related trauma. It is the second most common form of stroke, accounting for approximately 10% to 15% of new strokes. The 30 day mortality is very high (25-50%). Hypertension is the most common cause. Unfortunately, surgery has not proven to be helpful except in certain exceptions such as in large cerebellar hemorrhage. Nonetheless, it is very important that patients with ICH are admitted to an intensive care or a stroke unit with close surveillance of consciousness, focal neurologic symptoms, blood pressure and fluid balance.

Keywords: Spontaneous intracerebral hemorrhage, hypertension, cerebral amyloid angiopathy, raised intracranial pressure.  

Correspondence: Olafur Sveinsson, olafur.sveinsson@karolinska.se

See here table I

Figure texts

Figure 1. Hemorrhage in the basal ganglia and side ventricles due to hypertension. Published with permission from neuropathologyweb.org.

Figure 2. Lobar hemorrhage caused by Cerebral amyloid angiopathy. Published with permission from neuropathologyweb.org.

Figure 3. A head CT without contrast which shows an acute hemorrhage in the left occipital lobe. Around the hemorrhage one can see oedema. The lesion then proved to be a bleeding into a renal cancer metastas.   

Figure 4. CT of the brain demonstrate how a hemorrhage in the basal ganglia (a) enlarges in a few hours (b) with a subsequent deterioration in the patients health.

Figure 5 a) CT of the brain without contrast shows a hemorrhage in the left cerebellum. Figure b) shows how almost all the blood has been removed surgically.

Figure 6. CT without contrast shows a two cm in diameter hemorrhage in the pons.

Figure 7. CT without contrast (figure a) shows hemorrhage in the left hemisphere. CT- angiograhy after contrast injection (figure b) shows spot sign which is a sign of continual blood leakage and is a strong risk factor for further hematoma expansion. 

^{Sveinsson O1, Olafsson IH2, Kjartansson O3, Valdimarsson EM4}

¹Department of Neurology Karolinska Hospital, Stockholm, Sweden, ²Department of neurosurgery, University Hospital of Iceland, Reykjavík, Iceland, ³Department of radiology, University Hospital of Iceland, Reykjavík, Iceland, ⁴Department of neurology, University Hospital of Iceland, Reykjavík, Iceland.