Rupture of a brain vessel causes leakage of blood into the brain parenchyma, cerebrospinal fluid (CSF) spaces around the brain, or both. Bleeding injures the neighboring tissues by interrupting and cutting vital brain pathways, by exerting local pressure on the surrounding brain structures, and by causing ischemia of tissues adjacent to the hematoma. Further increase in intracranial pressure (ICP) causes shifts and herniations of brain tissues and may compress the brain stem. There are two large subcategories of spontaneous intracranial hemorrhages. Intracerebral hemorrhage (ICH) is bleeding in the brain parenchyma itself, and subarachnoid hemorrhage (SAH) refers to bleeding around the brain into the subarachnoid spaces and CSF. These two types of hemorrhages have different etiologies, clinical courses, and outcomes and thus require different management strategies.
The differential diagnosis of stroke is depicted in Figure..4.5-2 .
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