A hematoma within the brain parenchyma is known as intracerebral hematoma. Although it is difficult to define whether it is contusion or true ICH, it has been reported that they make up at least 30% of all intracranial hematomas.

Etiopathogenesis:

They result from bleeding from damaged vessels deep in the brain following a trauma.

Acute ICH is mainly of primary type resulting from arterial bleeding.

When it results from damage to vessels of the brain surface in the focus of cerebral contusion or laceration, it is called secondary hematomas.

The majority of both forms occur on the site of cerebral contusion-in the frontal and temporal regions. Initially they may be small foci, small fusing bleedings. Hypoxia and acidification of brain tissues enhance permeability of the vessels resulting in intracerebral  hematomas.

Toxic action of extravasated blood results in brain edema and raised ICP. ICH may lead to coagulopathy due to release of thromboplastin from the brain parenchyma.

The traumatic ICHs are most frequently occur in the temporal, frontal, and parieto-occipital areas.

Clinical features: Decreased level of consciousness, focal signs and symptoms predominate. Diagnosis is by CT or MRI scanning.
Management:	pri.traumatic  ICH	sec.traumatic  ICHs

A decisive factor in the management is the clinical picture.

If the GCS is between 3- 9 with no other obvious cause, most surgeons recommend surgical evacuation and decompression, especially if the ICH is easily accessible. Stereotactic aspiration is an emerging technique. Other patients may be treated conservatively and monitored periodically with serial CTs.

Multiple hemorrhages, especially bilateral, will not benefit from surgical evacuation.

Aggressive medical management must accompany any surgical intervention.

The final outcome depends on the preoperative status of the patient.