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The location of a primary intracerebral hemorrhage (ICH) plays a large role in identifying the underlying cause and prognosis.1 Deep ICHs, located in the basal ganglia or brainstem, are associated with arteriolosclerosis due to aging, hypertension, and other conventional vascular risk factors, and they have a low rate of recurrence (≈1%/y–2%/y) if blood pressure is well controlled. Lobar ICHs, located in the cortex or underlying white matter, may instead be associated with cerebral amyloid angiopathy (CAA) caused by vascular amyloid deposition and are associated with several-fold higher risk of recurrence. MRI can further risk-stratify patients by identifying microbleeds or cortical superficial siderosis, indicating past asymptomatic bleeding events.1 In patients with lobar ICH, evidence of superficial siderosis or microbleeds restricted exclusively to lobar locations increases the probability that the underlying cause is CAA,2 and they are associated with a high risk for recurrence.
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