Bleeding into or around the brain can cause significant pathology in and of itself. Intracerebral hemorrhage secondary to hypertension is a frequent occurrence. Degenerative changes in the vessel wall combined with increased perfusion pressure produce rupture of the vessel. This occurs most often in short circumferential vessels supplying the basal ganglia (80%) and pons (10%). The resulting hemorrhage may produce a hematoma with mass effect or it may resolve with time leading to cavitation, granulation tissue formation, and fibrosis.
Other etiologies of intracerebral hemorrhage include: i) blood dyscrasias; ii) vascular malformations; iii) congophilic angiopathy; iv) Duret hemorrhage; v) hemorrhagic neoplasms, and vi) mycotic aneurysms.