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