Imaging of Central Nervous System Hemorrhage

Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS, FCCM Neuroimaging p. 73-103 February 2023, Vol.29, No.1 doi: 10.1212/CON.0000000000001219
Article as PDF
-- Select an option --

OBJECTIVE This article aims to familiarize the reader with the various types of nontraumatic central nervous system (CNS) hemorrhage and the various neuroimaging modalities used to help diagnose and manage them.

LATEST DEVELOPMENTS According to the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study, intraparenchymal hemorrhage accounts for 28% of the global stroke burden. In the United States, hemorrhagic stroke makes up 13% of all strokes. The incidence of intraparenchymal hemorrhage increases substantially with age; thus, despite improvements in blood pressure control through various public health measures, the incidence is not decreasing as the population ages. In fact, in the most recent longitudinal study of aging, autopsy findings showed intraparenchymal hemorrhage and cerebral amyloid angiopathy in 30% to 35% of patients.

ESSENTIAL POINTS Rapid identification of CNS hemorrhage, which includes intraparenchymal hemorrhage, intraventricular hemorrhage, and subarachnoid hemorrhage, requires either head CT or brain MRI. Once hemorrhage is identified on the screening neuroimaging study, the pattern of blood in conjunction with the history and physical examination can guide subsequent neuroimaging, laboratory, and ancillary tests as part of the etiologic assessment. After determination of the cause, the chief aims of the treatment regimen are reducing hemorrhage expansion and preventing subsequent complications such as cytotoxic cerebral edema, brain compression, and obstructive hydrocephalus. In addition, nontraumatic spinal cord hemorrhage will also be briefly discussed.

Address correspondence to Dr Ryan Hakimi, 200 Patewood Dr, Ste B350, Greenville, SC 29615, [email protected].

RELATIONSHIP DISCLOSURE: Dr Hakimi has received personal compensation in the range of $0 to $499 for serving as a delegate in the American Medical Association House of Delegates for the American Society of Neuroimaging and in the range of $500 to $4999 for serving as the immediate past president for the South Carolina Osteopathic Medical Society and as a medical reviewer for the Office of Disciplinary Counsel in the South Carolina Department of Labor, Licensing and Regulation and has received publishing royalties from Osler, Hoskin & Harcourt LLP. Dr Hakimi has a noncompensated relationship as an annual meeting course committee member with the Neurocritical Care Society that is relevant to AAN interests or activities.


© 2023 American Academy of Neurology.