A Standardized Anatomical Classification of Intracranial Hemorrhage

BACKGROUND: Intracranial hemorrhage (ICrH) is an umbrella term that encompasses any hemorrhage within the skull. The underlying mechanisms, clinical presentations, and management strategies for ICrH vary considerably based on the anatomical location of the blood. However, the current terminology for ICrH is often ambiguous and inadequate for conveying the precise anatomical origins and extent of the hemorrhage, contributing to confusion and inconsistency in both clinical practice and research. To address these challenges, we identify six key shortcomings in current usage and propose a harmonized terminology for anatomical classification. SUMMARY: We propose the following clarifications: (i) intraparenchymal hemorrhage (IPH) refers to any hemorrhage within the parenchyma of the brain or the brainstem; (ii) isolated intraventricular hemorrhage (IVH) denotes hemorrhage confined to the ventricles, whereas extended IVH represents IPH extension into the ventricles; (iii) intracerebral hemorrhage (ICH) includes IPH and/or IVH; (iv) ICrH encompasses all hemorrhage within the skull (i.e., intraparenchymal, intraventricular, subarachnoid, subdural and epidural hemorrhages); (v) precise anatomical terminology should be favored over the ambiguous term "hemorrhagic stroke"; and (vi) the term "hemorrhage" indicates an active hemorrhage process, whereas "hematoma" describes the resulting mass or collection of blood. KEY MESSAGES: We invite stroke physicians and researchers to use this harmonized terminology to standardize and facilitate communication, as well as the interpretation and translation of research findings.