Hypertensive hemorrhage is the most common etiology for atraumatic IPH and is often supported by clinical history of hypertension and associated imaging findings of a single deep IPH in the basal ganglia, thalamus, pons, or cerebellum. Cerebral amyloid angiopathy is the second most common cause of IPH. Without pathological conformation, it can be diagnosed with acceptable accuracy based on MRI [87]. Diagnostic evaluation of IPH is directed at determining causes for IPH that may require specific interventions beyond supportive care for the IPH itself. These include arteriovenous malformation, dural arteriovenous fistula, CVT, cortical venous thrombosis, aneurysm, central nervous system neoplasms, cerebral hyperperfusion syndromes in the setting of carotid revascularization, metastatic disease, cavernous malformations, and Moyamoya disease. In cases of typical hypertensive hemorrhage or cerebral amyloid angiopathy, additional imaging may not even be warranted [87,88]. This variant focuses on imaging follow-up of patients previously diagnosed with IPH. Patients with IPH may require advanced monitoring or undergo emergent neurosurgical intervention depending on the degree of associated mass effect, edema, and the rate of expansion associated with the hemorrhage. Many potential etiologies for IPH may require both vascular imaging and advanced parenchymal imaging for full evaluation, if not previously performed during initial imaging triage. Arteriography Cervicocerebral Catheter-directed arteriography is the reference standard for identifying vascular lesions in patients with IPH. However, catheter angiography is an invasive procedure, and noninvasive vascular imaging studies are typically preferable as first-line vascular imaging once hemorrhage is identified. Catheter angiography is useful to further characterize vascular malformations, particularly if suggested by noninvasive testing.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. Hypertensive hemorrhage is the most common etiology for atraumatic IPH and is often supported by clinical history of hypertension and associated imaging findings of a single deep IPH in the basal ganglia, thalamus, pons, or cerebellum. Cerebral amyloid angiopathy is the second most common cause of IPH. Without pathological conformation, it can be diagnosed with acceptable accuracy based on MRI [87]. Diagnostic evaluation of IPH is directed at determining causes for IPH that may require specific interventions beyond supportive care for the IPH itself. These include arteriovenous malformation, dural arteriovenous fistula, CVT, cortical venous thrombosis, aneurysm, central nervous system neoplasms, cerebral hyperperfusion syndromes in the setting of carotid revascularization, metastatic disease, cavernous malformations, and Moyamoya disease. In cases of typical hypertensive hemorrhage or cerebral amyloid angiopathy, additional imaging may not even be warranted [87,88]. This variant focuses on imaging follow-up of patients previously diagnosed with IPH. Patients with IPH may require advanced monitoring or undergo emergent neurosurgical intervention depending on the degree of associated mass effect, edema, and the rate of expansion associated with the hemorrhage. Many potential etiologies for IPH may require both vascular imaging and advanced parenchymal imaging for full evaluation, if not previously performed during initial imaging triage. Arteriography Cervicocerebral Catheter-directed arteriography is the reference standard for identifying vascular lesions in patients with IPH. However, catheter angiography is an invasive procedure, and noninvasive vascular imaging studies are typically preferable as first-line vascular imaging once hemorrhage is identified. Catheter angiography is useful to further characterize vascular malformations, particularly if suggested by noninvasive testing.