Intracranial Hemorrhage Medication

  • Author: David S Liebeskind, MD; Chief Editor: Helmi L Lutsep, MD   more...
 
Updated: Nov 17, 2011
 

Medication Summary

Antihypertensive agents reduce blood pressure to prevent exacerbation of intracerebral hemorrhage. Osmotic diuretics, such as mannitol, may be used to decrease intracranial pressure. As hyperthermia may exacerbate neurological injury, acetaminophen may be given to reduce fever and to relieve headache. Anticonvulsants are used routinely to avoid seizures that may be induced by cortical damage. Vitamin K and protamine may be used to restore normal coagulation parameters. Antacids are used to prevent gastric ulcers associated with intracerebral hemorrhage.

Accumulating data suggest that statins have neuroprotective effects; however, their association with intracerebral hemorrhage outcome has been inconsistent.[12] Antecedent use of statins prior to intracerebral hemorrhage is associated with favorable outcome and reduced mortality after intracerebral hemorrhage. This phenomenon appears to be a class effect of statins.

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Antihypertensive agents

Class Summary

These agents reduce blood pressure to prevent exacerbation of intracerebral hemorrhage.

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Labetalol (Normodyne, Trandate)

 

Antagonizes adrenergic receptors, thereby reducing blood pressure.

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Nicardipine (Cardene, Cardene SR)

 

Calcium channel blocker. Potent rapid onset of action, ease of titration, and lack of toxic metabolites. Effective but limited reported experience in hypertensive encephalopathy.

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Osmotic diuretics

Class Summary

Osmotic diuretics reverse pressure gradient across the blood-brain barrier, reducing intracranial pressure.

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Mannitol (Osmitrol, Resectisol)

 

Reduces cerebral edema with help of osmotic forces and decreases blood viscosity, resulting in reflex vasoconstriction and lowering of intracranial pressure.

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Antipyretics, analgesics

Class Summary

These agents reduce fever and relieve pain.

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Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)

 

Reduces fever, maintains normothermia, and reduces headache.

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Anticonvulsants

Class Summary

These agents reduce the frequency of seizures and provide seizure prophylaxis.

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Fosphenytoin (Cerebyx)

 

Diphosphate ester salt of phenytoin that acts as water-soluble prodrug of phenytoin. Following administration, plasma esterases convert fosphenytoin to phosphate, formaldehyde, and phenytoin. Phenytoin in turn stabilizes neuronal membranes and decreases seizure activity.

To avoid need to perform molecular weight-based adjustments when converting between fosphenytoin and phenytoin sodium doses, express dose as phenytoin sodium equivalents (PE). Although can be administered IV and IM, IV route is route of choice and should be used in emergency situations.

Concomitant administration of IV benzodiazepine usually necessary to control status epilepticus. Full antiepileptic effect of phenytoin, whether given as fosphenytoin or parenteral phenytoin, not immediate.

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Antidotes

Class Summary

This agent reverses some coagulopathies or bleeding diatheses.

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Phytonadione; vitamin K (Konakion, Mephyton, AquaMEPHYTON)

 

Promotes hepatic synthesis of clotting factors that inhibit warfarin effects.

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Protamine

 

Forms a salt with heparin and neutralizes its effects.

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Antacids

Class Summary

These agents provide prophylaxis of gastric ulcers.

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Famotidine (Pepcid)

 

Minimizes development of gastric ulcers.

Competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and hydrogen concentration.

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Contributor Information and Disclosures
Author

David S Liebeskind, MD  Associate Professor of Neurology, Program Director, Vascular Neurology Residency Program, University of California, Los Angeles, David Geffen School of Medicine; Neurology Director, Stroke Imaging Program, Co-Medical Director, Cerebral Blood Flow Laboratory, Associate Neurology Director, UCLA Stroke Center

David S Liebeskind, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Society of Neuroimaging, American Society of Neuroradiology, National Stroke Association, and Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey L Saver, MD, FAHA, FAAN  Professor of Neurology, Director, UCLA Stroke Center, University of California, Los Angeles, David Geffen School of Medicine

Jeffrey L Saver, MD, FAHA, FAAN is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Neurological Association, and National Stroke Association

Disclosure: University of California The University of California Regents receive funds for consulting services on clinical trial design provided to Telecris, Ev3, and CoAxia. Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Howard S Kirshner, MD  Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Helmi L Lutsep, MD  Professor, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, Oregon Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association

Disclosure: Co-Axia Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Concentric Medical Consulting fee Review panel membership

References

  1. [Best Evidence] Hallevi H, Dar NS, Barreto AD, Morales MM, Martin-Schild S, Abraham AT, et al. The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications. Crit Care Med. Mar 2009;37(3):969-74, e1. [Medline].

  2. Kernan WN, Viscoli CM, Brass LM, et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med. Dec 21 2000;343(25):1826-32. [Medline].

  3. Vespa PM, O'Phelan K, Shah M, Mirabelli J, Starkman S, Kidwell C, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology. May 13 2003;60(9):1441-6. [Medline].

  4. Woo D, Haverbusch M, Sekar P. Effect of untreated hypertension on hemorrhagic stroke. Stroke. Jul 2004;35(7):1703-8. [Medline].

  5. Wada R, Aviv RI, Fox AJ, Sahlas DJ, Gladstone DJ, Tomlinson G, et al. CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage. Stroke. Apr 2007;38(4):1257-62. [Medline].

  6. Bang OY, Buck BH, Saver JL, Alger JR, Yoon SR, Starkman S, et al. Prediction of hemorrhagic transformation after recanalization therapy using T2*-permeability magnetic resonance imaging. Ann Neurol. Aug 2007;62(2):170-6. [Medline].

  7. Nishihara T, Nagata K, Tanaka S. Newly developed endoscopic instruments for the removal of intracerebral hematoma. Neurocrit Care. 2005;2(1):67-74. [Medline].

  8. [Best Evidence] Mayer SA, Brun NC, Begtrup K. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. Feb 24 2005;352(8):777-85. [Medline].

  9. Zaaroor M, Soustiel JF, Brenner B, Bar-Lavie Y, Martinowitz U, Levi L. Administration off label of recombinant factor-VIIa (rFVIIa) to patients with blunt or penetrating brain injury without coagulopathy. Acta Neurochir (Wien). Jul 2008;150(7):663-8. [Medline].

  10. Honner SK, Singh A, Cheung PT, Alter HJ, Dutaret CG, Patel AK, et al. Emergency department control of blood pressure in intracerebral hemorrhage. J Emerg Med. Oct 2011;41(4):355-61. [Medline].

  11. Qureshi AI, Palesch YY, Martin R, Novitzke J, Cruz-Flores S, Ehtisham A. Effect of systolic blood pressure reduction on hematoma expansion, perihematomal edema, and 3-month outcome among patients with intracerebral hemorrhage: results from the antihypertensive treatment of acute cerebral hemorrhage study. Arch Neurol. May 2010;67(5):570-6. [Medline].

  12. Biffi A, Devan WJ, Anderson CD, et al. Statin use and outcome after intracerebral hemorrhage: Case-control study and meta-analysis. Neurology. May 3 2011;76(18):1581-8. [Medline].

  13. Finelli PF, Kessimian N, Bernstein PW. Cerebral amyloid angiopathy manifesting as recurrent intracerebral hemorrhage. Arch Neurol. Mar 1984;41(3):330-3. [Medline].

  14. Ritter MA, Droste DW, Hegedus K. Role of cerebral amyloid angiopathy in intracerebral hemorrhage in hypertensive patients. Neurology. Apr 12 2005;64(7):1233-7. [Medline].

  15. Castellanos M, Leira R, Tejada J. Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages. J Neurol Neurosurg Psychiatry. May 2005;76(5):691-5. [Medline].

  16. [Best Evidence] Alberts MJ, Latchaw RE, Selman WR. Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke. Jul 2005;36(7):1597-616. [Medline].

  17. Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg. Apr 1989;70(4):530-5. [Medline].

  18. Bang OY, Saver JL, Alger JR, Shah SH, Buck BH, Starkman S, et al. Patterns and Predictors of Blood-Brain Barrier Permeability Derangements in Acute Ischemic Stroke. Stroke. Nov 26 2008;[Medline].

  19. Bang OY, Saver JL, Liebeskind DS, Starkman S, Villablanca P, Salamon N, et al. Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis. Neurology. Mar 6 2007;68(10):737-42. [Medline].

  20. Bradley WG Jr. MR appearance of hemorrhage in the brain. Radiology. Oct 1993;189(1):15-26. [Medline].

  21. Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. Jun 2007;38(6):2001-23. [Medline].

  22. Broderick JP, Brott T, Tomsick T, et al. Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg. Feb 1993;78(2):188-91. [Medline].

  23. Broderick JP, Brott TG, Tomsick T, et al. Ultra-early evaluation of intracerebral hemorrhage. J Neurosurg. Feb 1990;72(2):195-9. [Medline].

  24. [Best Evidence] Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. Jan 27 2007;369(9558):293-8. [Medline].

  25. Chiquete E, Ruiz-Sandoval MC, Alvarez-Palazuelos LE, Padilla-Martínez JJ, González-Cornejo S, Ruiz-Sandoval JL. Hypertensive intracerebral hemorrhage in the very elderly. Cerebrovasc Dis. 2007;24(2-3):196-201. [Medline].

  26. Connor MD, Modi G, Warlow CP. Accuracy of the Siriraj and Guy's Hospital Stroke Scores in urban South Africans. Stroke. Jan 2007;38(1):62-8. [Medline].

  27. Demaerschalk BM, Aguilar MI. Treatment of acute intracerebral hemorrhage. Curr Treat Options Neurol. Nov 2008;10(6):455-67. [Medline].

  28. Derex L, Nighoghossian N. Intracerebral haemorrhage after thrombolysis for acute ischaemic stroke: an update. J Neurol Neurosurg Psychiatry. Oct 2008;79(10):1093-9. [Medline].

  29. Fiehler J, Remmele C, Kucinski T. Reperfusion after severe local perfusion deficit precedes hemorrhagic transformation: an MRI study in acute stroke patients. Cerebrovasc Dis. 2005;19(2):117-24. [Medline].

  30. Flemming KD, Wijdicks EF, St Louis EK, Li H. Predicting deterioration in patients with lobar haemorrhages. J Neurol Neurosurg Psychiatry. May 1999;66(5):600-5. [Medline].

  31. Greenberg SM. Cerebral amyloid angiopathy: prospects for clinical diagnosis and treatment. Neurology. Sep 1998;51(3):690-4. [Medline].

  32. Hankey GJ, Hon C. Surgery for primary intracerebral hemorrhage: is it safe and effective? A systematic review of case series and randomized trials. Stroke. Nov 1997;28(11):2126-32. [Medline].

  33. Hart RG, Boop BS, Anderson DC. Oral anticoagulants and intracranial hemorrhage. Facts and hypotheses. Stroke. Aug 1995;26(8):1471-7. [Medline].

  34. Ivascu FA, Howells GA, Junn FS. Rapid warfarin reversal in anticoagulated patients with traumatic intracranial hemorrhage reduces hemorrhage progression and mortality. J Trauma. Nov 2005;59(5):1131-7; discussion 1137-9. [Medline].

  35. Juvela S, Heiskanen O, Poranen A, et al. The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg. May 1989;70(5):755-8. [Medline].

  36. Kang HS, Han MH, Kwon OK, Kwon BJ, Kim SH, Oh CW. Intracranial hemorrhage after carotid angioplasty: a pooled analysis. J Endovasc Ther. Feb 2007;14(1):77-85. [Medline].

  37. Kassner A, Roberts T, Taylor K. Prediction of hemorrhage in acute ischemic stroke using permeability MR imaging. AJNR Am J Neuroradiol. Oct 2005;26(9):2213-7. [Medline].

  38. Khatri P, Broderick JP, Khoury JC, Carrozzella JA, Tomsick TA. Microcatheter contrast injections during intra-arterial thrombolysis may increase intracranial hemorrhage risk. Stroke. Dec 2008;39(12):3283-7. [Medline].

  39. Khatri P, Wechsler LR, Broderick JP. Intracranial hemorrhage associated with revascularization therapies. Stroke. Feb 2007;38(2):431-40. [Medline].

  40. Kidwell CS, Chalela JA, Saver JL. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. Oct 20 2004;292(15):1823-30. [Medline].

  41. Klatsky AL, Friedman GD, Sidney S. Risk of hemorrhagic stroke in Asian American ethnic groups. Neuroepidemiology. 2005;25(1):26-31. [Medline].

  42. Lees KR, Zivin JA, Ashwood T. NXY-059 for acute ischemic stroke. N Engl J Med. Feb 9 2006;354(6):588-600. [Medline].

  43. Leira R, Davalos A, Silva Y. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology. Aug 10 2004;63(3):461-7. [Medline].

  44. Liu-DeRyke X, Rhoney D. Hemostatic therapy for the treatment of intracranial hemorrhage. Pharmacotherapy. Apr 2008;28(4):485-95. [Medline].

  45. Lo WD, Lee J, Rusin J, Perkins E, Roach ES. Intracranial hemorrhage in children: an evolving spectrum. Arch Neurol. Dec 2008;65(12):1629-33. [Medline].

  46. Lu A, Tang Y, Ran R. Brain genomics of intracerebral hemorrhage. J Cereb Blood Flow Metab. Feb 2006;26(2):230-52. [Medline].

  47. Mascitelli L, Pezzetta F, Goldstein MR. Hemorrhagic stroke in the SPARCL study. Stroke. Nov 2008;39(11):e180; author reply e181. [Medline].

  48. Mayer SA, Rincon F. Treatment of intracerebral haemorrhage. Lancet Neurol. Oct 2005;4(10):662-72. [Medline].

  49. Mitchell P, Mitra D, Gregson BA, Mendelow AD. Prevention of intracerebral haemorrhage. Curr Drug Targets. Jul 2007;8(7):832-8. [Medline].

  50. Narayan RK, Maas AI, Marshall LF, Servadei F, Skolnick BE, Tillinger MN. Recombinant factor VIIA in traumatic intracerebral hemorrhage: results of a dose-escalation clinical trial. Neurosurgery. Apr 2008;62(4):776-86; discussion 786-8. [Medline].

  51. Nghiemphu PL, Green RM, Pope WB, Lai A, Cloughesy TF. Safety of anticoagulation use and bevacizumab in patients with glioma. Neuro Oncol. Jun 2008;10(3):355-60. [Medline].

  52. Nishijima DK, Dager WE, Schrot RJ, Holmes JF. The efficacy of factor VIIa in emergency department patients with warfarin use and traumatic intracranial hemorrhage. Acad Emerg Med. Mar 2010;17(3):244-51. [Medline].

  53. Nyquist P. Management of acute intracranial and intraventricular hemorrhage. Crit Care Med. Mar 2010;38(3):946-53. [Medline].

  54. Ogasawara K, Sakai N, Kuroiwa T, Hosoda K, Iihara K, Toyoda K, et al. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg. Dec 2007;107(6):1130-6. [Medline].

  55. Oppenheim C, Touze E, Hernalsteen D. Comparison of five MR sequences for the detection of acute intracranial hemorrhage. Cerebrovasc Dis. 2005;20(5):388-94. [Medline].

  56. Orakcioglu B, Becker K, Sakowitz OW, Unterberg A, Schellinger PD. Serial diffusion and perfusion MRI analysis of the perihemorrhagic zone in a rat ICH model. Acta Neurochir Suppl. 2008;103:15-8. [Medline].

  57. [Best Evidence] Prasad K, Mendelow AD, Gregson B. Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database Syst Rev. Oct 8 2008;CD000200. [Medline].

  58. Qureshi AI, Mohammad YM, Yahia AM. A prospective multicenter study to evaluate the feasibility and safety of aggressive antihypertensive treatment in patients with acute intracerebral hemorrhage. J Intensive Care Med. Jan-Feb 2005;20(1):34-42. [Medline].

  59. Qureshi AI, Suri MF. Acute reversal of clopidogrel-related platelet inhibition using methyl prednisolone in a patient with intracranial hemorrhage. AJNR Am J Neuroradiol. Nov 2008;29(10):e97. [Medline].

  60. Rincon F, Mayer SA. Current treatment options for intracerebral hemorrhage. Curr Treat Options Cardiovasc Med. Jun 2008;10(3):229-40. [Medline].

  61. Rincon F, Mayer SA. Intracerebral hemorrhage: getting ready for effective treatments. Curr Opin Neurol. Feb 2010;23(1):59-64. [Medline].

  62. Runchey S, McGee S. Does this patient have a hemorrhagic stroke?: clinical findings distinguishing hemorrhagic stroke from ischemic stroke. JAMA. Jun 9 2010;303(22):2280-6. [Medline].

  63. Sandercock P. 'Yes' or 'no' to routine statins after subarachnoid hemorrhage to prevent delayed cerebral ischaemia, vasospasm, and death? A cautionary tale of 2 meta-analyses. Stroke. Jan 2010;41(1):e1-2. [Medline].

  64. Smith EE, Rosand J, Greenberg SM. Hemorrhagic stroke. Neuroimaging Clin N Am. May 2005;15(2):259-72, ix. [Medline].

  65. Sorimachi T, Fujii Y, Morita K, Tanaka R. Predictors of hematoma enlargement in patients with intracerebral hemorrhage treated with rapid administration of antifibrinolytic agents and strict blood pressure control. J Neurosurg. Feb 2007;106(2):250-4. [Medline].

  66. Steiner T, Rosand J, Diringer M. Intracerebral hemorrhage associated with oral anticoagulant therapy: current practices and unresolved questions. Stroke. Jan 2006;37(1):256-62. [Medline].

  67. Struffert T, Doelken M, Adamek E, Schwarz M, Engelhorn T, Kloska S, et al. Flat-detector computed tomography with intravenous contrast material application in experimental aneurysms: comparison with multislice CT and conventional angiography. Acta Radiol. May 2010;51(4):431-7. [Medline].

  68. Tuhrim S, Dambrosia JM, Price TR, et al. Prediction of intracerebral hemorrhage survival. Ann Neurol. Aug 1988;24(2):258-63. [Medline].

  69. Vernooij MW, van der Lugt A, Ikram MA, Wielopolski PA, Niessen WJ, Hofman A, et al. Prevalence and risk factors of cerebral microbleeds: the Rotterdam Scan Study. Neurology. Apr 1 2008;70(14):1208-14. [Medline].

  70. Viswanathan A, Chabriat H. Cerebral microhemorrhage. Stroke. Feb 2006;37(2):550-5. [Medline].

  71. Zhu XL, Chan MS, Poon WS. Spontaneous intracranial hemorrhage: which patients need diagnostic cerebral angiography? A prospective study of 206 cases and review of the literature. Stroke. Jul 1997;28(7):1406-9. [Medline].

 
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Intracranial hemorrhage. CT scan of right frontal intracerebral hemorrhage complicating thrombolysis of an ischemic stroke.
Intracranial hemorrhage. Fluid-attenuated inversion-recovery, T2-weighted, and gradient echo MRI illustration of intracerebral hemorrhage associated with a right frontal arteriovenous malformation.
Intracranial hemorrhage. Fluid-attenuated inversion-recovery, T2-weighted, and gradient echo MRI depiction of left temporal intracranial hemorrhage due to sickle cell disease.
This MRI reveals petechial intracerebral hemorrhage (ICH) due to cerebral venous thrombosis.
This CT scan and MRI revealed midbrain intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) associated with a cavernous angioma.
This MRI reveals hemorrhagic transformation of an ischemic infarct.
Table 1. MRI Appearance of Intracerebral Hemorrhage
PhaseTimeHemoglobinT1T2
Hyperacute< 24 hoursOxyhemoglobin (intracellular)Iso or hypoHyper
Acute1-3 daysDeoxyhemoglobin (intracellular)Iso or hypoHypo
Early subacute>3 daysMethemoglobinHyperHypo
Late subacute>7 daysMethemoglobin (extracellular)HyperHyper
Chronic>14 daysHemosiderin (extracellular)Iso or hypoHypo
Table 2. Grading of Subependymal Hemorrhage
GradeHemorrhage Location
ISubependymal hemorrhage
IIIntraventricular hemorrhage without ventriculomegaly
IIIIntraventricular hemorrhage with ventriculomegaly
IVIntraventricular hemorrhage with parenchymal hemorrhage
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