include hemorrhagic transformation of infarction which is usually in a classic vascular distribution and is seen in approximately 24 to 48 hours following the ischemic event. This hemorrhage rarely extends into the ventricular system. Pathophysiology Nontraumatic intraparenchymal hemorrhage most commonly results from hypertensive damage to blood vessel walls e.g.: - hypertension - eclampsia - drug abuse, but it also may be due to autoregulatory dysfunction with excessive cerebral blood flow e.g.: - reperfusion injury - hemorrhagic transformation - cold exposure - rupture of an aneurysm or arteriovenous malformation (AVM) - arteriopathy (e.g. cerebral amyloid angiopathy, moyamoya) - altered hemostasis (e.g. thrombolysis, anticoagulation, bleeding diathesis) - hemorrhagic necrosis (e.g. tumor, infection) - venous outflow obstruction (e.g. cerebral venous sinus thrombosis). Nonpenetrating and penetrating cranial trauma can also be common causes of intracerebral hemorrhage. Diagnosis Computed tomography (CT scan): A CT scan may be normal if it is done soon after the onset of symptoms. A CT scan is the best test to look for bleeding in or around your brain. In some hospitals, a perfusion CT scan may be done to see where the blood is flowing and not flowing in your brain. Magnetic resonance imaging (MRI scan): A special MRI technique (diffusion MRI) may show evidence of an ischemic stroke within minutes of symptom onset. In some hospitals, a perfusion MRI scan may be done to see where the blood is flowing and not flowing in your brain. Angiogram: a test that looks at the blood vessels that feed the brain. An angiogram will show whether the blood vessel is blocked by a clot, the blood vessel is narrowed, or if there is an abnormality of a blood vessel known as an aneurysm. Carotid duplex: A carotid duplex is an ultrasound study that assesses whether or not you have atherosclerosis (narrowing) of the carotid arteries. These arteries are the large blood vessels in your neck that feed your brain. Transcranial Doppler (TCD): Transcranial Doppler is an ultrasound study that assesses whether or not you have atherosclerosis (narrowing) of the blood vessels inside of your brain. It can also be used to see if you have emboli (blood clots) in your blood vessels. Treatment Intracerebral hemorrhages is a severe condition requiring prompt medical attention. Treatment goals include lifesaving interventions, supportive measures, and control of symptoms. Treatment depends on the location, extent, and cause of the bleeding. Often, treatment can reverse the