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Spontaneous intracranial haemorrhage (ICH) accounts for 10–15% of strokes. The pattern of haemorrhage, together with the patient's age and comorbidities influence the investigation and management.
Haemorrhage may be parenchymal, subdural, intraventricular or subarachnoid (SAH). The patient experiences sudden onset headache, with or without focal deficit, altered level of consciousness, seizures, nausea and vomiting. Extradural haemorrhage is usually traumatic (as is subdural), but spontaneous acute subdural haematoma may be caused by aneurysm rupture (in particular of middle cerebral and posterior communicating artery aneurysms) (figure 1), haemorrhage secondary to dural fistulas (figure 2), spontaneous intracranial hypotension, haemorrhagic dural metastases and coagulopathies.
Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Joanna Wardlaw, Edinburgh, UK.
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