[Neuroimaging evaluation of intracerebral hemorrhage]

Spontaneous intracerebral hemorrhage (ICH) is responsible for 10-15% of all strokes. Standard evaluation includes a CT examination, in which ICH is initially hyperdense but gradually decreases in density over days to weeks. In emergency situations, native CT can be supplemented with CT angiography, which reliably shows aneurysms and other vascular abnormalities larger than 2-3 mm. For detecting ICH in hyperacute situations, MRI is as sensitive as CT but signal characteristics are more complex, strongly depending on the oxygenation status of hemoglobin and the redox status of iron. In terms of localization, deep ICH in typical locations with hypertensive etiology is differentiated from atypical lobar ICH. Atypical ICH in elderly patients is often caused by cerebral amyloid angiopathy. Despite advances in noninvasive imaging techniques, today most atypical ICH patients still require digital subtraction angiography for a complete evaluation. In contrast, hypertensive ICH can be assumed in patients with known arterial hyperstension and ICH in a typical location.