Etiology, pathology and prognosis of intracerebral hemorrhage

1. Big picture

Intracerebral hemorrhage (ICH) is bleeding directly into the brain parenchyma. It accounts for about 10–15% of all strokes but carries the highest early mortality of any stroke subtype.

The exam wants three things:

1. Etiology — why the vessel bled (hypertension and amyloid angiopathy dominate).
2. Pathology — what the hematoma does to the brain (mass effect, perihematomal edema, secondary injury).
3. Prognosis — what predicts death and disability (volume, level of consciousness, ventricular extension, age, location).

Core exam idea: Deep ICH (basal ganglia, thalamus, pons, cerebellum) in a hypertensive patient = hypertensive bleed from small perforating vessels. Lobar ICH in an elderly normotensive patient = cerebral amyloid angiopathy.

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