Clinical Challenges in the Management of Atypical Spontaneous Intracerebral Hemorrhages

The common causes of spontaneous intracerebral hemorrhages (ICHs) include several etiologies, such as hypertensive angiopathy and cerebral amyloid angiopathy. In addition, varied etiologies can present with spontaneous ICHs. Management of these patients depends on a high index of suspicion and appropriate investigations depending on the underlying probable etiology of the hemorrhage. In clinical practice, it is important to be aware of the etiological and imaging characteristics of secondary hemorrhages as the management and outcome of these patients shall vary from cases to cases. There is a need to further expand the existing classification of ICH into primary and secondary hemorrhages where the other factors such as location deep versus superficial, underlying pathologies, for example, structural lesions or medication-related hemorrhages can be taken into consideration.