Learning Radiology xray montage
 
 
 
 
 

Hemorrhagic Stroke



    • Hemorrhage occurs in about 15% of strokes

    • Hemorrhage is associated with a higher morbidity and mortality than ischemic stroke

    • In the majority of cases, there is associated hypertension

    • About 60% of hypertensive hemorrhages occur in the basal ganglia

    • Other areas involved are the thalamus, pons and cerebellum

    • The decision to utilize thrombolytic therapy is based on algorithms formulated by the initial non-enhanced CT scan findings

    • Treatment should be initiated within one hour after the patient arrives at the hospital to provide its maximum benefit

    • Recognizing intracerebral hemorrhage (in general)

      • Freshly extravasated whole blood with a normal hematocrit will be visible as increased density (hyperdensity, hyperattenuation) on non-enhanced CT scans of the brain

      • This is due to the protein in the blood (mostly hemoglobin)
      • Dissection of blood into the ventricular system can occur in hypertensive intracerebral bleeds

      • As the clot begins to form, the blood becomes denser for about 3 days because of dehydration of the clot

      • After the 3rd day, the clot decreases in density and becomes invisible over the next several weeks

      • The clot loses density from the outside in so that it appears to shrink

      • After about two months, only a small hypodensity may remain

     

    Intracerebral hemorrhage

     

     

     
    Intracerebral hemorrhage, acute. Freshly extravasated whole blood, as this bleed into the thalamus (thin white arrow) will be visible as increased density on non-enhanced CT scans of the brain due primarily to the protein in the blood (mostly hemoglobin). As the clot begins to form, the blood becomes denser for about 3 days because of dehydration of the clot. After the 3rd day, the clot gradually decreases in density from the outside in and becomes invisible over the next several weeks.