Although only a minority of strokes are due to spontaneous hemorrhage (approximately 15 per cent), their importance lies in their severity, high mortality, and different management. The hemorrhage usually occurs as a result of the rupture of a Charcot-Bouchard aneurysm, a microscopic aneurysm that develops in small intracerebral vessels usually as a response to sustained arterial hypertension and the formation of microatheroma ( RussellJ963). Some hemorrhages are due to rupture of penetrating arteries themselves. In elderly patients, particularly those with the features of Alzheimer's disease and/or vascular dementia, amyloid angiopathy may be the cause of single or multiple superficial hematomas. Rarely, arteriovenous malformations, mycotic aneurysms, or anticoagulant drugs are responsible. Abuse of amphetamines or cocaine is another cause. Endocarditis also needs to be excluded in the intravenous drug user ( Warlow.1,991,) (Table 1).

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Table 1 Causes of cerebral hemorrhage

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