The acute haematoma is normally rounded homogeneous and hyperdense. With clot retraction, a surrounding rim of low-density oedema appears. A non-contrast-enhanced CT scan is always performed, if intracerebral 233

Fig. 5.18 Haemorrhagic infarct in the left middle cerebral artery territory. Note how the acute blood is limited to the middle cerebral artery territory.

haemorrhage is suspected. Otherwise it is not possible to distinguish acute blood from avid contrast enhancement (e.g. an avidly enhancing tumour).

Mass effect is often negligible and less than a tumour of a similar size. The haematoma can rupture into the ventriclular system and then cause hydrocephalus. Over a period of 1-2 weeks, the haematoma decreases in density starting in the periphery and working centrally. At this stage, contrast enhancement occurs peripherally due to formation of hypervascular granulation tissue.

Intracerebral haemorrhage is less common than infarction and a history of hypertension must be sought. Spontaneous rupture of the lenticulostriate arteries are frequently the cause and this explains why the basal ganglia are a common site.

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