Hemphill et al Management of Spontaneous ICH 2037 age <65 years, female sex, nonsmoker, lobar ICH, intraven- tricular extension, and absence of a history of hypertension MRI, magnetic resonance angiography, magnetic resonance venography, and CTA or CT venography can identify specific causes of hemorrhage, including arterio- venous malformations, tumors, moyamoya, and cerebral vein CTA has been more widely studied and is highly sensitive and specific for detecting vascular abnormali- A catheter angiogram may be considered if clinical suspicion is high or noninvasive studies are suggestive of an Radiological evidence suggestive of vascu- lar abnormalities as causative for ICH can include the presence of subarachnoid hemorrhage, enlarged vessels or calcifications along the margins of the ICH, hyperattenuation within a dural venous sinus or cortical vein along the presumed venous drain- unusual hematoma shape, presence of edema out of proportion to the time of presumed ICH, an unusual hemor- rhage location, and the presence of other abnormal structures in the brain (like a mass). Patients with lobar hemorrhage location, age <55 years, and no history of hypertension have a higher likelihood of identification of a secondary cause of ICH from additional MRI beyond noncontrast CT.66 An magnetic resonance venography or CT venography should be performed if hemorrhage location, relative edema volume, or abnormal signal in the cerebral sinuses on routine neuroimaging suggests cerebral vein thrombosis. In summary, ICH is a medical emergency that should be diagnosed and managed promptly. Hematoma expansion and early deterioration are common within the first few hours after onset. Emergency Diagnosis and Assessment: Recommendations 1. A baseline severity score should be performed as part of the initial evaluation of patients with ICH (Class I; Level of Evidence B). 