An ICH, classified as either primary or secondary, can be caused by a variety of factors (Table 1). Primary ICH refers to spontaneous hemorrhage from systemic hypertension. Hypertensive ICH usually occurs in middle-aged to older patients, and the hemorrhage might be attributed to small aneurysmal dilatations on the small, perforating cerebral arteries. These aneurysms are usually multiple, tend to occur in arteries <25 pm in diameter, and might attain a diameter of up to 2 mm. These microaneurysms are usually seen in hypertensive patients and are occasionally seen in normotensive patients and in those over 65 years of age. Secondary ICH can occur due to a variety of underlying structural abnormalities, including a ruptured cerebral aneu-rysm, arteriovenous malformation, other vascular malformation, cerebral amyloid angiopathy, tumors, trauma, and vasculitis. ICH can also occur secondary to coagulopathy that results from thrombocytopenia and anticoagulant therapy. Thrombolytic therapy for ischemic stroke is associated with a significant risk for ICH. Finally, sympathomimetic agents, such as cocaine and amphetamines, can cause an acute intense increase in blood pressure, resulting in ICH.
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