Causes of Intracranial Hemorrhage
| Cause | Location | Comments |
|---|---|---|
| Head trauma | Intraparenchymal: frontal lobes, anterior temporal lobes; subarachnoid; extra-axial (subdural, epidural) | Coup and contrecoup injury during brain deceleration |
| Hypertensive hemorrhage | Putamen, globus pallidus, thalamus, cerebellar hemisphere, pons | Chronic hypertension produces hemorrhage from small (~30-100 µm) vessels in these regions |
| Transformation of prior ischemic infarction | Basal ganglion, subcortical regions, lobar | Occurs in 1-6% of ischemic strokes with predilection for large hemispheric infarctions |
| Metastatic brain tumor | Lobar | Lung, choriocarcinoma, melanoma, renal cell carcinoma, thyroid, atrial myxoma |
| Coagulopathy | Any | Risk for ongoing hematoma expansion |
| Drug | Any, lobar, subarachnoid | Cocaine, amphetamine |
| Arteriovenous malformation | Lobar, intraventricular, subarachnoid | Risk is ~2-3% per year for bleeding if previously unruptured |
| Aneurysm | Subarachnoid, intraparenchymal, rarely subdural | Mycotic and nonmycotic forms of aneurysms |
| Amyloid angiopathy | Lobar | Degenerative disease of intracranial vessels; associated with dementia, rare in patients <60 years |
| Cavernous angioma | Intraparenchymal | Multiple cavernous angiomas linked to mutations in KRIT1, CCM2, and PDCD10 genes |
| Dural arteriovenous fistula | Lobar, subarachnoid | Produces bleeding by venous hypertension |
| Capillary telangiectasias | Usually brainstem | Rare cause of hemorrhage |