Spontaneous intracerebral hemorrhage classification

Hypertensive intracerebral hemorrhage

Fakan et al. classified spontaneous intracerebral hemorrhage as deep (Basal ganglia hemorrhage,Thalamic hemorrhage, Brainstem hemorrhage and lobar hemorrhage/cerebellar hemorrhage (i.e., cerebral amyloid angiopathy-compatible) ICHs. Probable/definite cerebral amyloid angiopathy was established using the modified Boston criteria in a subgroup with 'complete' radiological/neuropathological work-up ¹⁾.

Bogucki et al proposed a classification, supratentorial ICHs were divided into deep and cortico-subcortical. The deep group was further subdivided into striatocapsular, lobar ICH and isolated intraventricular haemorrhage and the cortico-subcortical group into paracisternal and convexity ICH. A new classification was used in a consecutive series of 108 patients with spontaneous supratentorial ICH subjected to angiographic evaluation.

Deep ICH in non-hypertensive patients was secondary to AVM rupture in 57.1% (8/14). High-flow vascular malformation was a source of bleeding in 93.6% of patients with paracisternal ICH - aneurysm in most cases (41/47). Convexity ICH was found to be AVM-related in 35.7% of patients (5/14).

The clinical experience shows that the proposed classification appears to be closely associated with angiographic findings. Its clinical application with consideration of other factors such as age and arterial hypertension may help clinicians to identify high-risk ICH patients for angiographic evaluation and further specific treatment to prevent rebleeding ²⁾.

Last revision March 2020