Cerebral Hemorrhage: Classification

Intracerebral hemorrhage is classified by etiology (cause) according to the guidelines of the German Society of Neurology:

  • Spontaneous intracerebral hemorrhage
    • Cryptogenic spontaneous intracerebral hemorrhage – the etiology has not yet been determined; however, it is believed that there is a cause
    • Idiopathic spontaneous intracellular hemorrhage – this form of hemorrhage has not yet been explained pathophysiologically
  • Secondary intracerebral hemorrhage (an underlying disease is detectable).
    • Arterial diseases
      • Diseases of the small vessels
        • Genetically determined diseases of the small vessels
        • Acquired diseases of the small vessels
      • Diseases of the large vessels
        • Moyamoya disease (from Jap. moyamoya “mist”) – disease of cerebral vessels in which there is narrowing or occlusion of cerebral arteries [sudden loss of vision in a child]; also occurs in adults.
        • Reversible cerebral vasoconstriction syndrome (RCVS): disorder that typically affects middle-aged women and occurs in association with the use of adrenergic or serotinergic agents. In addition to annihilation headache, multiple and multilocular vasospasms (vasospasms of vessels) occur on cerebral angiography (imaging technique for visualizing arteries and veins using contrast media)
        • Secondary hemorrhagic transformation
        • Cerebral vasculitis (inflammation of vessel walls in the brain).
        • Cerebral aneurysm – pathological (pathological) bulges of vessel walls in the brain.
    • Venous diseases
      • Cerebral venous and sinus thrombosis (CVT); symptoms: severe, acute onset, circumscribed headache; possibly also focal or generalized cerebral deficits (incidence (frequency of new cases): < 1.5/100,000 per year)
    • Vascular malformations (malformation).
      • Arteriovenous malformation – congenital malformation of blood vessels in which the arteries are directly connected to the veins
      • Dural arteriovenous fistula (dural fistula) – pathological short-circuit connection between the arteries and the veins at the level of the meninges.
      • Cerebral cavernous malformation – anlage disorder of the vascular system.
    • Coagulation disorders
      • Hematological diseases – diseases of the blood and blood-forming organs.
      • Iatrogenic coagulation disorders
      • Bleeding during therapy with anticoagulants (anticoagulants).
    • Intracerebral hemorrhage in the context of other diseases.
      • Substance abuse (alcohol, cocaine)
      • Infective endocarditis (inflammation of the inner lining of the heart)

Depending on the location of the hematoma, intracerebral hemorrhage can be divided into: