Acute CT Brain
Intracerebral haemorrhage/ICH

Key points

  • The appearances of spontaneous and traumatic intracerebral haemorrhage can be identical
  • Intracerebral haemorrhage is often accompanied by leakage into the extra-axial spaces

Intra-axial haemorrhage, or intracerebral haemorrhage (ICH), may be spontaneous or due to trauma. The radiological appearances may be identical as trauma does not always cause an accompanying fracture.

Spontaneous ICH - CT brain

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Spontaneous ICH

  • A large area of high density material (blood) is surrounded by low density (oedema)
  • This patient had a previous history of intractable hypertension and presented with sudden onset of right side weakness

Traumatic ICH - CT brain

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Traumatic ICH

  • This intracerebral haemorrhage has the same characteristics as the image of spontaneous haemorrhage shown above
  • The bone window image (inset) shows an adjacent skull fracture in this patient following head injury

Combined intra and extra-axial haemorrhage

Very often, intracerebral haemorrhage - whether spontaneous or traumatic - is accompanied by extension of bleeding into the extra-axial spaces (outside the brain).

ICH with subarachnoid extension - CT brain

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ICH with subarachnoid extension

  • This image shows a small intracerebral haemorrhage with surrounding oedema
  • High density material within the sulci indicates leaking of blood into the subarachnoid space
  • Note that the other images on this page also show extension of bleeding into the subarachnoid space

Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: July 2019