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Intracerebral hemorrhage (hemorrhagic stroke) generally presents in older, hypertensive patients with acute-onset headache and focal neurologic symptoms and signs.


  1. Intracerebral hemorrhage accounts for about 10% of strokes, being less common than embolic and thrombotic strokes.

  2. Hypertension is the most common cause, followed by amyloid angiopathy, saccular aneurysm rupture, and arteriovenous malformation rupture.

  3. Among patients with hypertension, Asians and blacks have the highest risk of hemorrhagic cerebrovascular accidents.

  4. In young patients (< age 40) without hypertension, diseases such as arteriovenous malformation, aneurysm rupture, and drug use should be considered.


  1. Patients with intracerebral hemorrhage usually have headache and focal neurologic signs.

  2. A thunderclap-type headache is the presenting sign in nearly 60% of patients.

  3. Vomiting is present in about 50% of patients, and seizures are present in about 10%.

  4. Noncontrast CT and MRI are equally accurate in making this diagnosis with sensitivities of nearly 100%. MRI may be better at detecting hemorrhagic transformation of ischemic strokes.


See the Treatment section under Cerebellar Hemorrhage in Treatment.

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