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Intraparenchymal hematoma of brain

Last edited: 4/23/2026

Overview

Intraparenchymal hematoma (IPH) refers to bleeding within the brain parenchyma, often resulting from trauma or vascular malformations, and can be further complicated by neoplastic involvement. 1

Diagnosis

  • MRI with MR Perfusion (MRP): Essential for detailed characterization.
  • Key MRP Parameters:
    • - Increased cerebral blood volume (CBV) and cerebral blood flow (CBF) show high sensitivity and specificity for neoplastic IPH (100% sensitivity, 88.9% specificity for CBV/CBF). - Peripheral linear enhancement on post-gadolinium MRI has 100% sensitivity but lower specificity (28.6%). - Nodular enhancement demonstrates moderate sensitivity (85.7%) and specificity (77.8%). 1

    Management

  • Surgical Evacuation: Primary treatment for large or symptomatic IPHs.
  • Medical Management:
    • - Blood pressure control to reduce intracranial pressure. - Monitoring and management of intracranial pressure with medications as needed.
  • No specific drug doses mentioned in provided abstracts.

    • Special Populations

  • No specific details provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts.

    • Key Recommendations

  • Utilize MR perfusion (MRP) with assessment of CBV, CBF, and enhancement patterns for distinguishing neoplastic from non-neoplastic IPH (Evidence: Moderate) 1
  • Consider surgical evacuation for patients with large or symptomatic IPHs (Evidence: Expert opinion)
  • Implement rigorous blood pressure management in all patients with IPH to mitigate secondary injury (Evidence: Moderate)

    • References

    1 Shankar JJS, Sinha N. Diagnosing Neoplastic Hematoma: Role of MR Perfusion. Clinical neuroradiology 2019. link

    Original source

    1. [1]
      Diagnosing Neoplastic Hematoma: Role of MR Perfusion. — Shankar JJS, Sinha N Clinical neuroradiology (2019)
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