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


