Fig. 3

Etiology. The figure illustrates the most common etiologies of ICH. Top row: Aneurysm—Bleeding from cerebral aneurysms may rarely present predominantly as ICH (top panel), such as this case of a bi-lobulated anterior communicating artery aneurysm (white arrows in CBCT 3D reconstruction in the bottom panel). Cavernoma—Bleeding in a cavernoma in the left hemisphere (top panel) with an associated DVA (black arrowheads and white arrows for the draining vein) and another cavernoma (black arrow) in the contralateral hemisphere on MRI (SWI). CAA (Cerebral Amyloid Angiopathy)—with a large parietal lobar ICH with the typical “finger-like projections” (top panel) and multiple amyloid deposits throughout the brain on a preceding MRI (SWAN, bottom panel). Ischemia—Illustrating an ICH an association with an acute ischemic stroke (top panel) caused by an embolic occlusion of the terminal internal carotid artery (T-occlusion—indicated by the white arrows in the CTA in the lower panel). Trauma—A common cause of ICH, illustrated by a temporal ICH in the left hemisphere, associated with an extracranial hematoma (white arrowheads in the top panel) and a skull fracture (black arrows in the 3D reconstruction in the bottom panel). Tumor—A large ICH in the right hemisphere with an underlying glioma, visualized on a subsequent MRI (T1-TSE with Gadolinium in the bottom panel). Vasculitis—A large frontal ICH associated with CNS vasculitis with several stenosed intracranial arteries (examples indicated by white arrowheads in the sagittal DSA in the bottom panel). Bottom row: AVM (ArterioVenous Malformation)—A temporal ICH where the AVM nidus (asterisk in all 3 panels) is protruding into the hematoma. The main feeder is indicated by white arrowheads (middle panel CTA and bottom panel DSA). DAVF (Dural ArterioVenous Fistula) – ICH with intraventricular extension adjacent to a DAVF (hematoma indicated by † in the CTA; middle panel) with an ectasia (asterisks in the middle and bottom panels) on a large draining vein (white arrowheads in the middle and bottom panels). Hypertensive microangiopathy—Typical location in the basal ganglia as this example with an ICH in the left thalamus, shown on CT (top panel) and MRI (T1 TSE in the middle panel and T2 FLARI in the bottom panel). Moya Moya—ICH caused by increased demand from thalamostriatal collateral vessels due to stenosis/occlusion of the distal internal carotid arteries (white arrows in the CTA in the middle panel and DSA in the lower panel). It is the collateral network of numerous small vessels that give rise to the typical “puff of smoke” appearance in advanced stages. Mycotic aneurysm—illustrated by a small ICH indicated by white arrowheads on CT (top panel) and MRI (SWI in the bottom panel) from a mycotic aneurysm on a distal MCA branch (white arrowhead in the CBCT angiography in middle panel) caused by septal emboli from staphylococcal endocarditis. Additional septic emboli seen on MRI are indicated by white arrows (SWI in the bottom panel). Sinus thrombosis—Illustrated by bilateral ICH in a case with extensive thrombosis of the superior sagittal sinus. The hyperdense appearance on NCCT (black arrowheads) is illustrated in the middle panel and the absence of superior sagittal sinus (white arrows on MR venography, bottom panel) and the torcula (white arrowhead in the bottom panel). Telangiectasia—Illustrated by an Ossler patient with a small frontal ICH where MR shows gadolinium enhancement in the lesion (white arrow in the middle panel; MR T1 TSE with Gadolinium) corresponding to a small telangiectasia without shunting on DSA (black arrow in bottom panel)