Stroke due to spontaneous intracerebral haemorrhage

Last reviewed: 22 Feb 2023
Last updated: 12 Oct 2022



History and exam

Key diagnostic factors

  • unilateral weakness or paralysis in the face, arm, or leg
  • sensory loss (numbness)
  • dysphasia
  • dysarthria
  • visual disturbance
  • photophobia
  • headache
  • ataxia
  • risk factors
Full details

Other diagnostic factors

  • vertigo
  • nausea/vomiting
  • decreased level of consciousness/coma
  • confusion
  • gaze paresis
Full details

Risk factors

  • hypertension
  • older age
  • male sex
  • Asian, black and/or Hispanic
  • heavy alcohol use
  • illicit sympathomimetic drugs
  • family history of intracerebral haemorrhage
  • haemophilia
  • cerebral amyloid angiopathy
  • autosomal dominant mutations in the COL4A1 gene
  • hereditary haemorrhagic telangiectasia
  • autosomal dominant mutations in the KRIT1 gene, CCM2 gene, or PDCD10 gene
  • anticoagulation
  • vascular malformations
  • Moyamoya disease
  • smoking
  • non-steroidal anti-inflammatories (NSAIDs)
  • diabetes mellitus
  • sympathomimetic medications
  • cerebral vasculitis
  • thrombocytopenia
  • leukaemia
Full details

Diagnostic investigations

1st investigations to order

  • non-contrast CT head
  • serum glucose
  • serum electrolytes
  • serum urea and creatinine
  • liver function tests
  • FBC
  • clotting screen
  • ECG
Full details

Investigations to consider

  • serum toxicology screen
Full details

Treatment algorithm


suspected intracerebral haemorrhage


confirmed intracerebral haemorrhage


Expert advisers

Matthew Jones, MD, FRCP

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Honorary Senior Lecturer

University of Manchester




MJ is the chair of the Association of British Neurologists Education Committee (unpaid position). MJ is a faculty member of an MRCP revision course.


BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Fernando D. Goldenberg, MD

Clinical Associate of Neurology

Medical Director, Neuroscience ICU

Director, Neurocritical Care Education

Co-Director, Stroke Center

University of Chicago



Raisa C. Martinez, MD

Neurocritical Care Fellow

Department of Neurology

University of Chicago




FDG and RCM declare that they have no competing interests.

Peer reviewers

David Werring, FRCP, PhD, FESO

Professor of Clinical Neurology

Head of Research Department, Brain Repair and Rehabilitation

UCL Institute of Neurology

Honorary Consultant Neurologist

National Hospital for Neurology and Neurosurgery

University College Hospitals NHS Foundation Trust

North Thames Clinical Research Specialty Lead for Stroke

NIHR Clinical Research Network




DW has received honoraria (speaking) from Bayer 2016, 2017, 2018 (talks or debates on intracerebral haemorrhage, atrial fibrillation, dementia) and honoraria (chairing) from Portola and Bayer 2019. DW has received consultancy fees from Bayer (2017; embolic stroke of undetermined source), JFB consulting (2018; PCSK9 inhibitors in stroke), Alnylam (2019; cerebral amyloid angiopathy), Portola (2019, 2020; andexanet alpha). JW was UCL Principle Investigator for NIHR clinical trials NAVIGATE-ESUS (Bayer, 2016-19), B2341002 (Pfizer 2014-2016), Action-2 (Biogen, 2016-19); Chief Investigator for OPTIMAS; steering committee and co-investigator for RESTART, TICH-2.


Helena Delgado-Cohen

Section Editor, BMJ Best Practice


HDC declares that she has no competing interests.

Tannaz Aliabadi-Oglesby

Lead Section Editor, BMJ Best Practice


TAO declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice


JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice


AM declares that he has no competing interests.

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