The Heidelberg Bleeding Classification

Abstract

Yet, not each intracranial hemorrhage detected by computed tomography (CT) or magnetic reso-nance imaging (MRI) worsens neurological symptoms and impairs outcomes. Consequently, intracranial hemorrhages after ischemic stroke and reperfusion therapy are classified by both imaging characteristics and the association with clinical worsening. Pure radiological classification uses the location, form, and extent of hemorrhage and its relation to ischemic injury to distinguish among hemorrhage subtypes that may differ in impairment of neurological function and prognosis. Mixed radiological–clinical classification adds clinical symp-toms to the presence of radiological hemorrhage to classify intracranial hemorrhages as symptomatic or asymptomatic. Historically, modern approaches to classifying hemor-rhage after reperfusion therapy began with the emphasis of Pessin et al 1 on the radiographic distinction between hemor-rhagic infarction (HI) and parenchymatous hematoma (PH) after embolic stroke. They stated that HI refers to the patho-logical condition in which petechial or more confluent hemor-rhages occupy a portion of an area of ischemic infarction. PH in an area of infarction; in contrast, is a solid clot of blood with mass effect, which displaces and destroys brain tissue.