Large intracerebral haemorrhage (ICH)
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Large intracerebral haemorrhage (ICH)
- A large area of increased density (white) represents acute bleeding into the brain parenchyma
- Low density surrounding the blood indicates adjacent cerebral oedema
- ICH is commonly associated with mass effect - this image shows effacement of the sulci and ventricles, and shift of midline structures
Clinical information
- History of hypertension
- Sudden onset of headache and left hemiparesis
- Worsening level of consciousness since arrival in the emergency department
Intraventricular haemorrhage
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Intraventricular haemorrhage
- Intracerebral haemorrhage may extend into the CSF spaces
- In this image bleeding extends into the left lateral ventricle
Clinical information
- History of hypertension
- Sudden onset right hemiparesis
Infarct with haemorrhagic transformation
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Infarct with haemorrhagic transformation
- Intracerebral haemorrhage may occur as a complication of cerebral infarction - a phenomenon known as 'haemorrhagic transformation'
- The large area of low density seen in the grey and the white matter is due to a large infarct of the right middle cerebral artery territory
- The high density area within the infarct is due to haemorrhagic transformation
Clinical information
- Sudden onset left hemiparesis (infarct)
- Conscious and stable on initial assessment
- Rapid unconsciousness (haemorrhagic transformation)
- Note: Haemorrhagic transformation is more common in anticoagulated patients and following thrombolysis therapy for an ischaemic infarct