ABSTRACT
This chapter covers both natural and traumatic Intracerebral haemorrhage (ICHs) concentrating, in particular, on diagnostic issues on neuropathological examination. Acute contusions typically occur over the crests of the gyri and have a conical appearance with the widest part in the superficial position and the apex deeper. Infiltration by inflammatory cells/leukocyte polymorphs is the first stage to be seen, initially with intravascular accumulation, but subsequently in the perivascular location. The relationship between development of such a haematoma and pre-existing disease, e.g. hypertension, is unclear. The common sites are over the hemispheres or cerebellum where the brain is exposed to the relevant object. The mechanism of contre-coup contusional injury has been the subject of considerable work. Lacerating injury may be seen in either coup or contre-coup contusional injuries. The pattern is seen macroscopically and more readily microscopically with small haemorrhages occurring around blood vessels.
