Intracerebral Hemorrhage (ICH) — CT Brain (Non-contrast)

 

Intracerebral Hemorrhage (ICH) — CT Brain (Non-contrast)

Key radiological features (concise):




1. Hyperdense Intraparenchymal Lesion

  • Acute blood = hyperdense (bright) (≈60–80 HU)
  • Common sites: basal ganglia (putamen), thalamus, lobar, cerebellum, brainstem

2. Surrounding Edema

  • Hypodense rim around hematoma (perihematomal edema)
  • Develops within hours → increases over days

3. Mass Effect

  • Effacement of sulci, ventricles
  • Midline shift (quantify if needed)
  • Compression of adjacent structures

4. Intraventricular Extension

  • Hyperdense blood in ventricles
  • May show fluid–fluid level / layering
  • Risk of acute hydrocephalus

5. Shape & Margins

  • Typically irregular or round/oval
  • May have heterogeneous density (active bleed, clot retraction)
  • “Swirl sign” → hypodense areas within clot (ongoing bleeding)

6. Location Clues (Etiology hint)

  • Deep (putamen/thalamus) → hypertensive
  • Lobar → amyloid angiopathy, tumor, AVM
  • Multiple → metastasis, coagulopathy

7. Evolution (brief)

  • Hyperacute (0–6 h): hyperdense ± swirl
  • Subacute (days): density ↓ (isodense ~1–2 weeks)
  • Chronic: hypodense cavity ± encephalomalacia

Mnemonic: “HEMATOMA”

  • Hyperdensity
  • Edema
  • Mass effect
  • Atypical density (swirl)
  • Topography (site clues)
  • Outflow into ventricles
  • Margins irregular
  • Age-dependent change
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