Spontaneous intraparenchymal haemorrhage without underlying structural abnormality; causes approximately 10% of all strokes (3/4 of ischaemic stokes)

Aetiology

• Hypertension is the most common cause - rupture of microaneurysms and degeneration of small, deep, penetrating arteries are the principal pathologies
• Cerebral amyloid angiopathy
• Secondary - arteriovenous malformations, cavernomas, aneurysms and dural venous thrombosis

Pathophysiology

Clinical features

• At the bedside, there is no entirely reliable way of distinguishing between haemorrhage and ischaemic infarcts
• Intracerebral haemorrhage is more often associated with severe headache or coma
• Patients on oral anticoagulants should be assumed to have had a haemorrhage unless it is proved otherwise

Investigations

• Imaging: CT brain, CTA, DSA, MRI

Management

• Essentially supportive
• Surgical decompression probably most beneficial to the well but deteriorating patient with lobar haemorrhage